Standard Adult CPR/AED

CPR stands for Cardiopulmonary Resuscitation i.e. to help restart the heart (pulse) and lungs (breathing). Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest.

CPR is an emergency procedure used with the purpose of restoring oxygenated blood back to the brain and heart during cardiac arrest.

• Chest compressions, which keep oxygenated blood flowing and circulating to the brain and heart
• Rescue breathing, which provides oxygen to the lungs

Death is likely to occur after 10 minutes of loss of oxygen to the brain. If you are afraid to do CPR or unsure how to perform CPR correctly, know that it’s always better to try than to do nothing at all. The difference between doing something and doing nothing could be someone’s life.

Immediate CPR can double, or even triple, a victim’s chances of survival!

CPR is useful in many emergencies, such as a heart attack, near drowning, stroke, cardiac arrest, or choking.

Timing is very important. When the heart (pulse) and lungs (breathing) stop, the victim has 5 minutes before (gradual) brain damage starts to occur. If the victim is unconscious, not breathing, or has no pulse, CPR should be applied immediately!

CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving only chest compressions is recommended for untrained rescuers.

Protects individuals from legal liability for providing reasonable medical aid to an injured, ill, or imperil person.

Consent must first be obtained, either verbally or through a gesture. Do not provide CPR to a person that refuses your assistance. If the person refuses, activate EMS (call 9-1-1). Giving CPR without consent from the person is unlawful. Only provide care to a person that agrees.

Before providing CPR and before obtaining consent: Identify yourself to the victim, state your level of training, ask the victim whether you may help, explain what you observe and explain what you plan on doing.

When an individual is unable to give consent, such as confused, mentally impaired, seriously injured, or seriously ill, consent is implied. If the person is unconscious, assume they want your help.

EXPRESS CONSENT – Express Consent must be obtained from any conscious, mentally competent person. You must state you are CPR-trained and explain the CPR procedures you are planning on performing.

IMPLIED CONSENT – Implied Consent is obtained from an unconscious person in a life-threatening situation.

HEART – The heart beats continuously to pump blood to all parts of the body. It has four chambers: Right and left atrium and ventricles. The heart is located between your lungs in the middle of your chest, behind, and slightly to the left of your breastbone (sternum). Blood flows from the right side of the heart to the left side. The heart is connected to blood vessels (arteries and veins) which together make up the circulatory system.

LUNGS – Each person has two lungs underneath the ribcage: One on the left side and the one on the right. Lungs are part of the respiratory system, a group of organs and tissues that work together to help you breathe. The respiratory system’s main job is to move fresh air into your body while removing waste gasses.

The right side of your heart receives blood from the body through the main blood vessels (veins) and pumps it to the lungs. The lungs fill the blood with oxygen and then send it back to the heart. The left side of the heart receives this oxygen-rich blood from the lungs and pumps it out to the rest of the body through the main blood vessels.

It is commonly assumed that when a person experiences a heart attack the person is also experiencing sudden cardiac arrest. This is not the case! A heart attack is not the same as a cardiac arrest. Here are the differences:

CARDIAC ARREST occurs when the heart stops beating suddenly. Electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. The Lack of blood flow to the brain and other organs can cause a person to lose consciousness, become disabled, or die if not treated immediately!

HEART ATTACK happens when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest. The more time that passes without treatment to restore blood flow, the greater the damage to the heart.

The American Heart Association has established a “hands-only” technique for untrained rescuers or individuals who do not have a medical background or formalized training. Hands-Only CPR does not require mouth-to-mouth ventilation measures since blood oxygen levels usually remain adequate for several minutes after cardiac arrest from a non-respiratory cause. That means giving uninterrupted chest compressions of 100-120 a minute until paramedics arrive. Hands-Only CPR has better outcomes than performing no CPR at all!

CPR can keep oxygen-rich blood flowing to the brain and other organs until emergency medical treatment can restore a typical heart rhythm. When the heart stops, the body no longer gets oxygen-rich blood.

Chest compressions are the foundation of CPR. All rescuers, regardless of training, should provide chest compressions to all cardiac arrest victims. Because of their importance, chest compressions should be the initial CPR action for all victims regardless of age.

The American Heart Association recommends a distinct pathway of care when an individual experiences cardiac arrest:

1. Recognition of Cardiac Arrest.
2. Activation of the (EMS) Emergency Response System (Call 911).
3. Cardiopulmonary Resuscitation (CPR) – Chest Compressions.
4. Rapid Defibrillation.
5. Await the arrival of professionally trained emergency providers.
6. Transport the victim to a higher level of care (post-cardiac arrest care).
7. Recovery (including additional treatment, observation, rehabilitation, and psychological support).

Cardiac Arrest symptoms are immediate and drastic: Sudden collapse. No pulse. No breathing. Warning signs and symptoms can appear up to two weeks before cardiac arrest: Chest pain, shortness of breath, unexplained fainting or dizziness, fatigue, or a racing heart.

Heart Attack symptoms include pressure, tightness or squeezing chest pain, or discomfort. Feeling weak. Light-headed. Pain or discomfort in the jaw, neck, or back. Pain or discomfort in one or both arms or shoulders. Shortness of breath. Cold sweat.

The American Heart Association has changed the sequence from the old sequence of A-B-C (Airway, Breathing, Compressions) to the new sequence of C-A-B (Compressions, Airway, and Breathing). Breaths prior to initiating compressions are no longer needed. Compressions should be initiated immediately if no pulse is present!

Before starting CPR, check the following:

• Is the environment safe for the person?
• Is the person conscious or unconscious?
• If the person appears unconscious, tap, or shake his or her shoulder and ask loudly, “Are you OK?”
• If the person doesn’t respond and you’re with another person who can help, have one person call 911 or the local emergency number and get the AED if one is available. Have the other person begin CPR.
• If you are alone and have immediate access to a telephone, call 911 or your local emergency number before beginning CPR. Get the AED if one is available.

1. Ensure the scene is safe.
2. Call for help and get or call for an automated external defibrillator (AED).
3. Check for responsiveness, observe for breathing, and check for a pulse.
4. Begin chest compressions with the correct ratio.
5. Deliver two breaths.
6. Resume chest compressions with the correct ratio.
7. Continue compressions-to-breath ratio until AED and/or help arrives.

SCENE SAFETY

Anytime you approach a victim, check the environment around you to ensure it is safe and free from hazards. Use all of your senses to check for hazards, such as traffic, unstable structures, downed electrical lines, moving water, violence, explosions, or toxic gas exposure. Key items to consider when checking for safety:

• DANGER: Make sure you or the victim are not at risk for something dangerous to occur. If you suspect a head, neck, or back injury do not move the victim. Only move the victim if they are in harm’s way for you to provide safe care.
• HELP: Call for help and look around for others who may be of assistance to you or to initiate the emergency response system.
• LOCATION: Look around and note details about your location. Emergency response teams can arrive faster if you can help provide a detailed description of your location.

CALL FOR HELP

Since mobile devices have become the standard use for communication the American Heart Association has identified that mobile devices can be used to activate the emergency response system without leaving the victim’s side. If you are alone and do not have a mobile device, leave the victim to activate the emergency response system. If others are present, send someone else to call for help.

911 dispatchers have been trained to recognize cardiac arrest and can provide anyone with dispatch-guided CPR instructions until the professionally trained emergency team arrives.

CHECK RESPONSIVENESS AND PULSE

First assess the victim to ensure CPR is needed. Check for life-threatening conditions, including unconsciousness, absence of breathing, absence of pulse, and severe bleeding. To check for responsiveness, you need to shake or tap the victim and shout, “are you ok?”. If there is no response and or breathing is absent quickly check for the victim’s pulse.

The pulse should be assessed by palpating the carotid artery. Do not spend much time on this step (only spend a maximum of 10 seconds assessing/feeling for a pulse). The directive to “look, listen, and feel for breathing” to aid recognition is no longer recommended.

CAROTID ARTERY: This artery is located on both the left and right side of the neck. To feel a heartbeat in this artery, you will need to press two fingers (the index and middle finger together) against either the left or right side of the neck below the jawline. If a heartbeat is present, you will feel a pulsating pressure against your fingers.

C – CHEST COMPRESSIONS

Compressions mean you’ll use your hands to push down hard and fast in a specific way on the person’s chest. The prompt initiation of effective chest compressions is a fundamental aspect of cardiac arrest resuscitation. Improving circulation through high-quality chest compressions is the most critical component of performing CPR. Chest compressions restore partial circulation to the heart and brain by building up and maintaining blood flow throughout the body to the brain and heart.

DELIVERING HIGH-QUALITY COMPRESSIONS:

• Put the person on his/her back on a solid firm surface before you start compressions.
• Kneel next to the victim’s neck and shoulders.
• Proper hand position is fundamental to delivering proper compressions. The rescuer should place one heel of one hand with the other hand over the top of the first hand over the breastbone (middle of the chest in alignment with the nipples or sternum).
• Once in position, lock your elbows and use your body’s weight to compress at least 2 inches upon the patient’s chest at 90 degrees to the victim’s chest.
• The recommended rate of compressions is at least 100-120 compressions per minute. The American Heart Association suggests performing compressions to the beat of the song “Stayin’ Alive”.
• Allow proper recoiling before the next compression.
• Minimize interruptions in compressions to no more than 10 seconds.
• Avoid excessive ventilation.

A – AIRWAY AND VENTILATION

Opening the airway is 2nd priority after beginning chest compressions. It is important when providing ventilation that you position the head, attain a good seal for rescue breathing, and provide adequate breaths in which you can visualize good, symmetrical chest rise breaths.

To open the airway, use the head-tilt-chin-lift maneuver to improve oxygenation and ventilation. This technique requires you to press down on the forehead with your palm and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. You will deliver two breaths (with each breath being delivered over 1 second) after the recommended number of compressions. Adequate breath delivery will cause the chest to rise symmetrically and bilaterally on both sides of the chest wall.

Once an advanced airway is in place, you may deliver one breath every 6 to 8 seconds, regardless of compression rate.

Once you have provided the victim with two adequate breaths, immediately resume CPR with 30 compressions being delivered. Continue the compression to breath ratio (30:2) of the CPR cycle until the victim recovers or help arrives. If an AED for adults is available, use it as soon as possible. Resume chest compressions immediately after the shock is given.

Note: The untrained rescuer can provide Hands-Only (Compressions-Only) CPR (compressions without ventilation).

VENTILATION WITH A MASK

Healthcare providers who have easy access to a bag mask for ventilation are encouraged to use the mask when performing ventilation. For bag-mask ventilation to be effective, a tight seal must form between the victim’s face and the mask. The most effective technique when using a mask to deliver oxygen to the victim is the “E-C Clamp” technique. The E-C clamp technique utilizes both hands to ensure a solid seal is present so the victim can receive adequate oxygen. First, lift the victim’s jaw toward the mask to open their airway. Then, squeeze the bag until the victim’s chest rises symmetrically and bilaterally on both sides of the chest wall.

If you are alone during CPR, bag-mask ventilation is not recommended due to the complex steps required for the proper use of the technique. Bag-mask ventilation can be provided effectively during 2-person CPR.

B – BREATHING

Rescue breathing can be performed mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can’t be opened. While giving mouth-to-mouth breathing pinch the victim’s nose shut. Current recommendations suggest performing rescue breathing using a bag-mask device.

Prepare to give two rescue breaths. Give the first rescue breath (lasting one second) and watch to see if the chest rises. If the chest rises, give a second breath. If the chest doesn’t rise, repeat the head-tilt, and chin-lift maneuver, and then give a second breath with a ratio of 30:2.

After the breathing technique is applied, continue Chest Compressions, Airway and Ventilation, Breathing (C-A-B).

COMPRESSIONS TO BREATH RATIO

The following chart shows the recommended compression to breath ratio based on the victim’s age:

An automated external defibrillator (AED) is a portable medical device designed to evaluate the heart rhythm and send an electric shock to victims of ventricular fibrillation to restore the heart rhythm to normal. AEDs are used to help those experiencing sudden cardiac arrest. Ventricular fibrillation is the uncoordinated heart rhythm most often responsible for sudden cardiac arrest. Early defibrillation remains the foundational therapy for ventricular fibrillation and pulseless ventricular tachycardia.

AEDs are devices that have pads or paddles, which are placed on a person’s chest during life-threatening emergencies. The device automatically calculates a person’s heart rhythm. If the person’s heart requires a shock to return to a normal rhythm, the device will prompt the user to administer a shock.

AEDs have been designed to give the bystanders or the untrained exact direction on how to use the device. It is imperative to follow the directions provided by the device exactly to receive the optimal results.

The integration of AEDs into the chain of survival is critical. To give the victim the best chance of survival, three actions must occur within the first couple of minutes during cardiac arrest:

1. Activation of Emergency Help.
2. Chest Compressions.
3. Operation of a Defibrillator.

• Make sure the defibrillator pads do not touch.
• AED pads may be placed on the victim while doing CPR.
• Chest compressions should not be paused unless AED is active.
• When the AED is analyzing a rhythm, everyone should stay clear from the victim.
• Do not touch the victim while the AED is analyzing. Touching or moving the victim may affect the analysis.
• When the AED recommends a shock to be delivered, everyone should stay clear from the victim.
• Before shocking the victim, make sure that no one is touching or is in contact with the victim or any resuscitation equipment.
• Verbalize clearance from the victim to avoid the likelihood of shocking bystanders.
• Do not defibrillate the victim when around flammable or combustible materials, such as gasoline or free-flowing oxygen.

• Remove the victim from the water before defibrillation. A shock delivered in water could harm rescuers or bystanders.
• Be sure there are no puddles of water around you, the victim, or the AED device.
• Remove wet clothing to place the AED pads properly.
• If it is raining, take steps to make sure the victim is as dry as possible and sheltered from rain and ensure the victim’s chest is wiped dry.

1. Open the AED, turn it on, and follow the voice prompts.
2. Remove clothing and attach the AED electrode pads to the correct spots. Remove all clothing covering the chest and abdomen.
3. If necessary, wipe the chest and abdomen dry. Do not use alcohol to wipe the victim’s chest dry. Alcohol is flammable.
4. Place one pad on the upper right side of the chest. Place the other pad on the lower side of the chest a few inches below the left armpit.
5. Allow the AED to analyze the heart rhythm.
6. If the AED advises a shock, clear the victim. Make sure no one is touching the victim. Say “CLEAR!” in a loud, commanding voice.
7. Press the Shock Button to deliver the shock.
8. After the AED delivers the shock, or if no shock is advised, immediately resume CPR, beginning with chest compressions.

It is important to remember that if you are not formally trained, hands-only CPR can be initiated by you or by a bystander. Research has proven that even if just chest compressions are performed without ventilation, survival rates are still increased. The key to a successful delivery of CPR is high-quality chest compressions.

NOTE: This online course should not replace live training with manikins and trained professionals. The only way to practice delivering high-quality compressions is through live training. This course has provided you with an overview of CPR and AEDs proper steps to initiate the process to save a victim in cardiac arrest in an emergency.

Remember the following:

• The importance of timeliness in performing CPR.
• Check for life.
• The signs and symptoms of a person in need of CPR.
• Before performing CPR call 911 or have someone else call.
• The correct procedure for performing CPR.
• Chest compressions: 100-120/minute
• (C-A-B) Chest Compressions, Airway and Ventilation, Breathing
• Use an AED device as soon as one is available.