A Simple Guide To Cardiopulmonary resuscitation (CPR) & Automated External Defibrillator (AED)

If a person is unresponsive (appears lifeless, doesn't move, and doesn't respond to your shout or a tap on the shoulder) and not breathing you need to start CPR (Cardiopulmonary resuscitation) right away. Gasping is not breathing! Being unresponsive means appearing lifeless, doesn’t move or respond when shoulder is tapped. Yell for someone to call EMS and get an AED. An AED applied fast may restart the heart. AEDs are user friendly and I’ve included instructions on how to operate one.

- Understand that when a victim's heart has stopped pumping blood (cardiac arrest), permanent brain damage can begin in six minutes, so you must act fast.
- Cardiac arrest can strike at any age and may be caused by many conditions, including heart attack, suffocation, allergic reaction, drowning, choking, or electric shock.

What a rescuer should do when CPR is needed depends on training. If you are not trained in CPR, you should start chest compressions immediately and follow instructions given by an EMS dispatcher. If you are CPR trained and able you should begin with chest compressions and then add rescue breathing, following current CPR guidelines. Research has shown that when chest compressions are given immediately to a cardiac arrest (unresponsive/not breathing) victim the chance of survival is improved.

Note: Healthcare providers, such as nurses and paramedics, learn more detailed instructions than what is covered in this book.

Chest-Compression-Only CPR
- Be sure you are safe.
- Tap and shout "Are you OK?" to assess responsiveness and look to see if the person is breathing---gasping is NOT breathing.
- If unresponsive, have someone call EMS and get an AED while you start chest compressions.
- Position the victim flat on a firm surface with head at the same level as the heart. Open chest clothing.
- Kneel facing the victim's chest. Place the heel of your hand on the center of the chest - the lower half of the breastbone/sternum.
- Place the heel of your other hand on top of the hand on the chest. With shoulders back, straighten your arms, lean directly over the person, and lock your elbows.
- Use straight-down pressure through both arms to push the breastbone down toward the spine, at least 2 in./5 cm. Push hard and fast at rate of 100 - 120 compressions a minute (100-120/min.). Allow chest to recoil between compressions. This is hard work. Don’t stop compressions unless absolutely necessary.
- You may be directed by an EMS dispatcher to perform rescue breaths.
- If a CPR barrier mask isn't available and you have any worries about giving rescue breathing or consider the victim at high risk for disease transmission say so. Your own safety is a priority.

Note: CPR on infants and children has better outcomes when chest compressions are combined with rescue breathing. This is best learned in a CPR class.

CPR Basics
Remember, proper functioning of the heart and lungs is basic to life. Monitoring responsiveness, which includes determining whether the person is breathing and their heart is pumping, takes priority over other illnesses and injuries. if you’re not breathing and your heart isn’t beating, stabilizing a fractured bone isn’t going to make much difference.

A trained lay rescuer (someone who has taken a CPR class) should provide, at a minimum, chest compressions. Rescue breaths can be added at a ratio of 30 compressions to 2 breaths. So if you find someone who is unresponsive, start right in with chest compressions and provide rescue breaths as you’ve been trained.

It’s correct to think chest Compression, Airway and Breathing (C-A-B) instead of Airway, Breathing and Circulation (A-B-C) when it comes to an unresponsive victim. However, if you’re monitoring someone who is having a seizure, for example, monitoring the person’s breathing is most important. Use your common sense and prioritize when it comes to monitoring a victim.

Remember, CPR involves the use of chest compressions and rescue breathing. During CPR, the trained rescuer attempts to maintain a steady flow of oxygen and blood for the victim, whose lungs and heart have stopped functioning.

It is best administered by a trained person. Remember:
C – Chest Compressions
A – Airway
B – Breathing

Here are the basics of single rescuer CPR for an adult:
- Do not move the victim if you suspect a back or neck injury unless to restore breathing or circulation—and then only use the Log-Roll Technique so the person moves as a unit.
- Do not tilt the head back to open the airway of a victim with a possible neck or spine injury.
- Do not press on the soft tissue of chin or neck during Rescue Breathing.

C – Compressions

To perform chest compressions on an adult:
- Position the victim flat on a firm surface with head at the same level as the heart. Open chest clothing
- Kneel facing the victim's chest. Place the heel of your hand on the mid chest - lower half breastbone/sternum. Then place your other hand on top. With shoulders back, straighten your arms, lean directly over the person, and lock your elbows.
- Use straight-down pressure through both arms to push breastbone down toward the spine, at least 2 in./5 cm. Push hard and fast at rate of 100 - 120/min.
- Release pressure after each compression, but don't let your hands come off the victim's chest. Do not pause between compressions. The compressions should be smooth, regular, and uninterrupted. Compression and relaxation time should be equal.
- After 30 compressions, breathe twice into the victim's mouth (each breath lasting 1 second).

FYI: Healthcare professionals are trained to check for a pulse.You should understand how this is done.
- Using your fingers (not thumb), gently feel the carotid artery on the victim's neck for at least 5 and no more than 10 seconds to find a pulse. 
(To find the carotid artery, put two fingers on the victim's Adam's apple [larynx]. 
Slide your fingers to your side and direct them into the groove between the windpipe and the muscle at the side of the neck. 
This is where the carotid artery is located.) Gently feel for a pulse.

If Pulse Is Present But There Is No Breathing 
- Perform Rescue Breathing at a rate of one breath every 5-6 seconds (10-12/min) until breathing is restored or help arrives.

Remember: If No Pulse Is Present - and medical help has been called, continue Chest Compressions until AED arrives.

A – Airway
Sometimes an obstruction has caused the victim to stop breathing. Here’s how to open a victim’s airway and clear an obstruction and prepare for rescue breathing:
- The most common cause of airway obstruction is the tongue. To keep the airway open perform the head-tilt, chin-lift. Place one hand on the victim's forehead and put the fingers of your other hand under the bony part of the chin. Press down on the forehead and lift out the chin so that the mouth is slightly open. If you suspect a spinal injury, do not press down on the forehead nor tilt the head back. Simply perform a chin lift. The victim may start to breathe after you open the airway. If the victim is breathing, and no spine injury is suspected, place in the Recovery Position.
- If an obstruction to the airway is visible and reachable and the victim is unconscious, remove the object with your fingers. (Gloves should be worn.)
- Never place your fingers in the mouth of a conscious or semiconscious individual. If the victim is conscious, give first aid for Choking.
If the airway is clear check breathing.

B – Breathing
Place your ear above the victim's mouth and nose. Watch for signs of breathing. Gasping is not breathing. If the victim isn’t breathing, start Rescue Breathing. 
(Use a CPR barrier mask if one is available.)

If you have any reservations about giving rescue breathing or consider the victim at high risk for disease transmission, perform Chest Compression – Only CPR.

Rescue Breathing
- Pinch the victim's nose to close nostrils, keeping the airway open by the head-tilt, chin-lift (using hand on the forehead).
- Take a breath and seal your lips around the outside of the victim's mouth, preferably with a CPR barrier mask, creating an airtight seal.
- Give the victim 2 full breaths (1 second each), taking your lips off the victim's mouth to inhale between each breath.
- Check for chest rising and falling with each breath you give. The rising of the chest during your exhalations indicates the effectiveness of your breaths.
- Perform 5 sets of the 30 compressions and 2 breaths within 2 minutes.
- Continue CPR until an AED is applied, the person starts to move, help arrives, or until you can no longer continue.

Automated External Defibrillator (AED)
CPR alone is not always enough to restart the heart. AEDs save lives if used right away for certain types of cardiac arrests. This computerized medical device analyzes the heart and delivers electric shock (defibrillation) when needed through connected adhesive pads. The AED and you work through visual ad audio prompts. Instructions are clear-cut and directions are given one step at a time.
The EMS dispatcher may tell you where the nearest AED is located and instruct you to send for it. AEDs are common in public places and also carried to the scene by trained responders. Smartphone Apps for some locales show the nearest AED and trained citizen willing to respond. Survival of victims is based on the time it takes to start CPR and defibrillation. Therefore, until the AED arrives, chest compressions should be done by pushing fast and hard on the chest. When an AED is available, lay rescuers should perform CPR while it is being applied.

Good to Know:
- Defibrillation can only save a heart stopped by specific rhythms.
- Pads for children, 1 to 8 years, are clearly marked.
- If the victim has lots of hair on his chest, remove the hair by applying an adhesive pad. Press down firmly and remove the pad with hair attached. Apply a fresh adhesive pad to hairless area.
- Chest muscles may jerk when shock is delivered.

What an AED does:
- Recognizes cardiac arrest from rhythms that requires electrical shock
- Warns when a shock is needed
- Gives a shock if needed
- Tells you to "stand clear" from the victim for your safety
- Do not use AED if victim is lying in water.
- Do not use AED if chest is covered with sweat or water.
- Do not put an AED pad over a medication patch, remove patch with glove and wipe area before applying AED pad.
- Do not place AED pad over a pacemaker (hard lump under chest skin).
- Do not touch a victim when AED says to "stand clear" or while delivering a shock.
- Do not use AED on infants less than 12 months.
- Do not use adult pads on children under age 8.
- If unresponsive and not breathing apply AED quickly. Visual displays show where to place the two adhesive pads on the victim's chest. Follow the voice prompts. You'll be instructed to "stand clear" while the machine is analyzing whether or not a shock is necessary.
- If delivery of a shock is required, you'll be prompted to "stand clear" again. If other people are on the scene, make sure no one is touching the victim. The machine will tell you when it is delivering a shock. Some devices instruct you to press the button to deliver the shock.
- The AED may also instruct you to start CPR.
- Perform CPR for 2 min. and reapply the AED.