Adult Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is indicated for any adult that is found to be pulseless and breathless, as long as obvious signs of death are not present. This would include:

• Decapitation
• Major open chest/cranial vault injuries
• Stiff cold extremities (rigor mortis)
• Obvious tissue decay

Always combine universal precautions with the appropriate
personal protective gear before initiating first aid and/or CPR on anyone!

The minimal universal precaution requirements for conducting CPR on any person of any age include protective exam gloves and the use of a barrier device when mouth-to-mouth rescue breathing is used.

The latest CPR guidelines have eliminated the "Look-Listen-Feel" portion of the life-saving intervention, including the initial pulse check for layperson rescuers. If an unconscious victim is breathing adequately, place them in the recovery position (as long as a spinal injury isn’t suspected) and monitor their breathing. If the victim is not breathing or is not breathing normally, such as gasping for breath, cardiopulmonary resuscitation is indicated immediately.

High-Quality, "Fast-n-Hard" Cardiopulmonary Resuscitation

The human body is strong with many vital functions and natural fail-safes that work non-stop to maintain life. However, without a continuous supply of oxygen delivered by a properly functioning heart and lungs, the vital organs will not be able to maintain their functions and will quickly begin to shut down. When this cascading event begins, irreversible brain damage and multi-system organ failure follow within four to six minutes.

Emergency Steps:

Remember: Check for scene safety first and the victim second!

Single Rescuer CPR

Check the scene to ensure the scene is safe.

Check the victim. In less than 10 seconds, determine if the victim is not responsive and isn’t breathing effectively (including gasping). Then begin the following steps.

Call for Help. Yell and shout for help. If someone is near, point to that person and have them immediately call 911. If you are alone with an adult, call 911 immediately. If you must leave the individual to call, place them in the recovery position.

Employ C, A, B, D. Compressions-Airway-Breathing-Defibrillation

Compressions

• 1. Quickly position the victim so they are lying flat on their back (supine position) on a hard stable surface (not a bed or sofa).
  (The victim should be positioned on a hard stable surface; not a bed or sofa)
• 2. Position yourself on either side of the victim near their upper chest. Compressions can be administered over clothing, but it is best to expose the entire chest (if it’s appropriate for the setting) so that the adequacy of the compressions and rescue breaths can be evaluated during the resuscitation effort.
• 3. Locate the proper hand position by placing the heel of one hand on the center of the victim’s sternum (breastbone). Your hand should now be on an imaginary line between the nipples. If you can feel the “notch” at the bottom of the sternum, you should move your hand up about two finger widths so that the heel of your hand is centered on the sternum. Place your other hand directly over the first hand. Try to keep your fingertips off the chest by interlacing them or holding them upward.
 

• 4. Position your body so that your shoulders are directly above your hands and the victim’s chest. Keep your arms straight for consistently powerful compressions. This position helps you to deliver smooth straight-down compressions.
 

 

• 5. Deliver “hard-and-fast” chest compressions at a rate of 100 to 120 per minute for an adult. A counting method such as “one and two and three and four” will help you keep a smooth and steady rhythm.
   
   
• Note: The term “hard and fast” refers to the new adult chest compression rate and depth recommendations. The proper chest compression depth for an adult is between 2 and 2.4 inches (5 to 6 cm). Compressions that are too shallow (less than 2 inches or 5 cm) will not effectively pump oxygenated blood throughout the body. Compressions that are too deep (more than 2.4 inches or 6 cm) can cause rib fractures and damage the victim’s heart. The delivery rate for adult chest compressions should be between 100 and 120 per minute. Compressions delivered at a rate less than this will not effectively pump oxygenated blood to the vital organs of the body. Compressions delivered too quickly will not effectively circulate blood because there isn’t enough time between compressions for the heart chambers to adequately fill with blood before being ejected with the next compression. Either way, the result is the same: ineffective CPR!
• 6. Allow the chest to fully recoil before initiating another compression. This allows the chambers of the heart to re-fill with blood before being “pumped out” by the next compression.
  However, do NOT remove your hands from their chest between compressions. This practice keeps the hands in the proper position and allows you to feel when the chest fully recoils.

Airway

• 7. After completing the first 30 chest compressions (about 15-17 seconds), open the victim's airway by using the head tilt/chin lift maneuver, as long as spinal trauma is not suspected. (If a spinal injury is suspected, perform compression-only CPR).
  With the victim flat on their back, place one hand on their forehead and the other hand underneath their chin. Gently push down on the forehead while lifting the chin to effectively open the victim’s airway. Avoid lifting on the chin too hard as this can close the mouth or cause unintentional injury.
   
  

Breathing

• 8. Once the head tilt/chin lift maneuver has been employed to open the victim’s airway, pinch the victim’s nose and deliver two rescue breaths through a barrier device such as a one-way valve to protect you both. Each rescue breath should take about one second to deliver and cause the chest to visibly rise and fall.
   
  

  If using a breathing mask or barrier please see directions below:

  

  Breathing masks cover the victim’s nose and mouth. The hand on the head is used to push down on the forehead while your fingers cup the mask and push it down to create a seal around the victim’s mouth. Your other hand is used to lift up on the chin to open the airway.

  

  Use the head tilt / chin lift maneuver when using a breathing barrier like pictured above.

• 9. Continue cycles of 30 chest compressions followed by 2 rescue breaths through an approved barrier device until EMS help or an AED arrives at the victim. Then CPR should continue until you’re prompted to stop for an AED analysis or a paramedic’s request.
   
  

Defibrillation

• 10. If an automated external defibrillator is being used in the resuscitation attempt, it is appropriate to continue CPR until the AED pads are properly adhered to the victim’s chest and/or back and the unit is powered up. However, all victim contact must cease once the AED is ready to begin an analysis of the victim’s cardiac rhythm. If the arrest is witnessed and an AED is readily available, it is now recommended to quickly attach the appropriate pads and analyze the victim for the presence of a shockable rhythm before initiating CPR or opening their airway. If the AED announces that a non-shockable rhythm is present, then CPR is initiated at that point. However, leave the AED attached and follow all prompts that may follow even though it didn’t indicate a shock initially.
  
  Different types of AEDs are readily available and saving lives across the country. There are several manufacturers, models, and functions, but they are all designed similarly for easy uniform use. Most modern AEDs have voice prompts that guide you from the moment the unit is powered up and have visual display screens and lighted buttons for easy use.
   
  

AED Operation:

• Turn on the automated external defibrillator (AED).
  Some units have an on/off button while some turn on automatically when the case is opened.
• Expose the victim's entire chest and ensure it is clean, dry, and free of debris to ensure the electrodes will adhere appropriately.
• Peel the backing off each pad individually before applying it to the victim's chest/back. Apply one pad to the upper right chest area and the other one on the left side of the victim's chest.
   
  
• Attach the cable to the AED unit, if necessary (some are one-piece units with cables permanently attached).
• Make sure that no one is touching the victim during the AED analysis by announcing, “Clear, everyone stand clear.”
  (It won’t hurt anyone touching the victim at this point, but it can cause a faulty analysis.)
• Analyze the victim’s cardiac rhythm by pushing the clearly marked analysis button.
  (Some newer models are automatic with voice prompts that will guide you through the analysis/defibrillation.)
   
  

If the AED determines a shock is required:

• Ensure that no one, including yourself, touches the victim during the analysis.
• Again, ensure all victim contact has ceased and announce “Clear, everyone stand clear.”
• Once you are positive that no one (including yourself) is touching the victim, push the shock button, if the unit is equipped with one. (Some newer units are automatic.)
   
  

'No shock needed' message or post-shock procedure:

• Initiate or continue TWO minutes of “fast-n-hard” CPR.
• Continue to follow the instructions given by the AED until EMS assistance arrives, the victim begins to breathe/move, or the scene becomes too unsafe to continue care.
   
  

Two-Rescuer CPR

If there are two first-responders trained in CPR at the scene to help, both should identify themselves as trained first-responders and work together to save the victim’s life. One rescuer should initiate cardiopulmonary resuscitation while the other rescuer immediately contacts 911.

The second responder can take over delivering “hard and fast” chest compressions when the first rescuer gets tired. The change should take place at the end of a cycle after two rescue breaths are delivered. The “fresh” rescuer begins on the very next compression cycle.

If both rescuers are trained and working well together, it is appropriate for one rescuer to deliver compressions while the other delivers 2 rescue breaths after every 30 compressions. The rescuers can change positions as needed for fatigue with the “fresh” rescuer taking over at the end of a cycle so they are delivering the next cycle of chest compressions. This method isn’t recommended for layperson rescuers that haven’t been properly trained in two-person CPR.


 


Let’s Review Adult CPR;

First:

Check the scene and make sure it is safe! Do not become a victim yourself!

Then:

C - Check the victim for consciousness. Tap the victim on the shoulder and shout, “are you okay?”

P - Phone for help or get someone to call 911. If you are alone with an adult, call for help immediately.

R - React by initiating life-saving interventions (C-A-B-D).

Compressions: Immediately begin chest compressions. Place the heel of one hand in the center of the victim's sternum and the other hand on top of it. Place your body directly over the adult and lock your arms. Give 30 chest compressions, pushing straight down at least 2" deep, but no more than 2.4". The compressions should be delivered at a rate of at least 100 per minute but no more than 120 per minute.

Airway: Open up the airway with the head tilt/chin lift method if spinal trauma isn't suspected. It is sometimes hard to tell if a spinal injury exists in a cardiac arrest victim. Your best bet is to assume there is a spinal injury if the victim was involved in any type of traumatic event, such as a car accident or a fall from a considerable distance. In the event of suspected spinal trauma, begin compression-only CPR

Breathing: Pinch the victim’s nose with the hand that is on the forehead. Deliver two rescue breaths that make the chest visibly rise.

Defibrillation: Turn on the AED (automated external defibrillator) and follow the voice prompts.

 

Congratulations!

You have completed the adult section of your CPR training. If you are comfortable with this material, please proceed to child/infant CPR. If you are unclear on any of the topics or procedures discussed, please review them before proceeding to the next section.

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