What is CPR?
CPR stands for CardioPulmonary Resuscitation i.e. to help restart the heart (pulse) and lungs (breathing). When do we perform CPR?
CPR is performed when a person stops breathing and/or the heart stops. Why is it important to learn CPR?
Every year about 350,000 people suffer cardiac arrest i.e. their heart stops. Sudden cardiac death is the most common cause of death in United States and Canada. If you know how to perform CPR you may be able to save a life.
Why timing is important?
When the heart (pulse) and lung (breathing) stops, the victim has 5 minutes before (gradual) brain death starts to occur, if no CPR is performed. Therefore, it is very important to start CPR as soon as possible. What is Hands-only CPR?
Any bystander who is not trained in CPR can perform this type of CPR to try to save a life. Hand-only CPR is better than no CPR. If you witnessed an adult or a child/infant who suddenly collapses then:

1. Call EMS / 911
2. Push hard and fast in the center of the chest | | Anatomy of Heart and Lungs
1. Heart
The heart beats continuously to pump blood to all parts of the body. It has four chambers: Right and left atrium and ventricles. Blood flows from the right side of the heart to the left side. The heart is connected to blood vessels (arteries and veins) which combined make up the circulatory system. 2. Lungs
Each person has two lungs underneath the ribcage: One on the left side and the one on the right. Its main function is to purify the blood i.e. from oxygen-poor blood to oxygen-rich blood. |

Physiology of Heart and Lungs:
The used (oxygen-poor) blood in the main blood vessels (veins) enters the heart from the right atrium. Oxygen has been removed from the used blood, by your body’s organs and tissues. The used blood then travels to the right ventricle, which in turn pumps the blood from the heart to the lungs. When you are breathing air in, the oxygen passes from your lungs to the blood vessels where it is added to your blood. Carbon dioxide, a waste product, is passed from the used blood, to the lungs and is removed from your body when you are breathing out. The oxygen-rich blood enters the heart from the lungs to the left atrium. The left atrium pumps the oxygen-rich blood, to the left ventricle which then pumps through aorta (main blood vessel), to the rest of the body. Cardiopulmonary Resuscitation | | | • Ensure the scene is safe
• Check for response
• If no response i.e. unresponsive and lack of normal breathing ( no breathing or only gasping), then
• Activate EMS (Emergency Medical Services) and get or call for AED (automated externaldefibrillator)
• Immediately start the chest compressions
• The rescuer should place the heel of one hand on the center (middle) of the victim's chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped, and the arms are locked at the elbow and at 90 degree to the victim's chest
• Start compression ( at least 2 inches in depth) at least 100 per minute. Allow complete chest recoil after each compression to allow heart to refill with blood.
• After 30 compressions, open the airway and give breaths – Head tilt-chin lift (push the forehead back with one hand and lift the chin to move the jaw forward with the other hand)
• Give 2 breaths, each for 1 second duration, look for chest rise. If the first breath doesn't make the chest rise and fall, then reposition the head i.e. head tilt-chin lift, and re administer the breaths. Give one breath, every 5-6 second intervals (10-12 breaths per minute).
• Continue 30 compressions followed by 2 ventilations i.e. ratio of 30:2
• AED should be used as soon as it is available, resume chest compressions immediately after the shock is given. |

| | One and Two Rescuer:
• 30:2 chest compressions to ventilations (breaths)
• For two rescuers: change the compressor/ rescuer every 2 minutes i.e. every 5 cycles to avoid fatigue.

Special Situations:
If a person is drowning or a victim of foreign body airway obstruction, complete the 5 cycle or 2 minutes of CPR before activating the EMS (If only one rescuer is present and the EMS has not been activated)

Summary:
• Recognition of cardiac arrest (no response and no breathing or only gasping breath)
• Activation of EMS
• Immediate CPR (chest compressions followed by breaths)
• Rapid use of AED if available

| 1 Rescuer
Compression to Ventilation ratio | 2 Rescuer Compression to Ventilation ratio |
Compressions |
Rescue Breaths |

Adult CPR | 30:2 | 30:2 |
- at least 100/minute
- at least 2 inches depth of the chest |
- 1 second duration
- Every 5-6 seconds
- 10-12 breaths/minute | |

| | chokingAdults :

Conscious and choking:

• Ask the victim, if he is choking
• If he is able to cough and speak, encourage him to cough
• If unable to speak or cough or severe trouble breathing, then perform abdominal thrusts - Heimlich maneuver |

Unconscious after choking:

• If victim collapses /becomes unconscious, then activate emergency medical services and get an AED (If two rescuers are present)
• The rescuer should then start chest compressions (without a pulse check)
• The rescuer should place the heel of one hand on the center (middle) of the victim's chest (which is the lower half of the sternum) and the heel of the other hand on top of the first so that the hands are overlapped, and the arms are locked at the elbow and at 90 degree to the victim's chest
• Chest compression (at least 2 inches in depth for an adult or at least 1/3rd the diameter of the chest compression for a child) should be at the rate of at least 100 compressions per minute.
• After 30 compressions, open the airway i.e. Head tilt - chin lift technique: push the forehead back with one hand and lift the chin to move the jaw forward with the other hand .
• Check for an object in the mouth, if you see an object then remove it.
• Give 2 breaths, each for 1 second duration, look for chest rise. If the first breath doesn't make the chest rise and fall, then reposition the head i.e. head tilt-chin lift, and re-administer the breaths. Give one breath, every 3-5 second intervals (12-20 breaths per minute).
• Continue 30 compressions followed by 2 ventilations (check for an object in the mouth each time before the ventilation, if you see an object then remove it) i.e. ratio of 30:2, until AED or EMS arrives.
• AED should be used as soon as it is available; resume chest compressions immediately after the shock is given (minimize interruptions ).
• Leave to activate emergency medical services and to get AED after 5 cycles or after 2 minutes (only if one rescuer is present and EMS has not been activated)

Automated External Defibrillator | | | When to use AED?
AED should be used on any adult or children (1-8 yrs), when there is, no response, no breathing and no pulse. Following is the sequence for AED use:
• If no response
• Activate EMS (for all witnessed adult and children cardiac arrest except for drowning adult and unwitnessed children, who would need 2min/ 5 cycles of CPR before activation of EMS) and get AED
• Begin CPR |

Automated External Defibrillator | | | How to use AED:
• Turn on AED
• Attach electrode pads (child’s pads for 1-8 yrs if available) to the victims bare chest. Place one on the upper right side of the bare chest to the right of the breast bone directly below the collar bone. Apply other pad to the left of the nipple, a few inches below the left arm pit. DO NOT use child’s pads or child’s system for adults.
• Attach the wires to the AED
• Press analyze. Clear the victim and allow AED to analyze the rhythm Shock advised:
If shock is advised then clear the victim and deliver a shock – press the shock button
After the shock, donot check the pulse, continue CPR – beginning with chest compressions. No Shock advised:
If no shock advised then continue CPR and reanalyze in 2 minutes. |

Special situations:
1. Water: wipe off the chest (snow and small puddle is OK)
2. Transdermal medication patches – remove patch
3. Chest hair- shave with razor and use new pads
4. Implanted devices- be at least 1 inch away from the pads. CPR techniques | | | Mouth to Mouth Breaths:
• Position yourself on the side of victim’s head
• Perform head tilt-chin lift
• Pinch the nose with your thumb and index finger
• Take a breath and seal your lips around the victim’s mouth, creating an airtight seal
• Give 1 breath – over 1 sec
• Observe for the visible chest rise, if chest doesn’t rise, repeat the head tilt-chin lift
• Give a second breath over 1 sec and watch for visible chest rise. |