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 rescue breaths.
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.

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

Step 3: Start 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. Note: If you do not feel comfortable doing rescue breathing, you can choose not to. Studies have shown that CPR can be effective with chest compressions alone.
• 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.

Positioning your hands for chest compressions:

• 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.
• Straighten your arms, lock your elbows, and center your shoulders directly over your hands.

Positioning your arms and body for doing chest compressions:

• 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 per minute. Be sure to let the chest re-expand at the end of each compression.
• After 30 compressions, give 2 rescue breaths.
• 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.

Positioning your hands for chest compressions:

• Use the heel of one hand to give compressions. You can use both hands as you would for an adult.
• Straighten your arm, lock your elbow, and center your shoulders directly over your hand.

Positioning your arms and body for doing chest compressions:

• 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 chest's depth for a child. Give 30 compressions at a rate of 100 compressions per minute. Be sure to let the chest re-expand at the end of each compression.
• After 30 compressions, give 2 rescue breaths.
• Keep repeating the cycle of 30 compressions and 2 breaths until help arrives or until the child is breathing normally.

For a baby under 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 per minute. Be sure to let the chest re-expand at the end of each compression.
• After 30 chest compressions, give 2 rescue breaths.
• Keep giving 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 to continue CPR and when to check again for a heart rhythm.

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Author:	Katy E. Magee, MA Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated: May 19, 2006
Medical Review:	Patrice Burgess, MD - Family Medicine Martin Gabica, MD - Family Medicine
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