How to Perform Adult CPR: Lifesaving Techniques to Restore Circulation and Oxygenation

This article explores the essentials of adult CPR, including the techniques and steps involved, empowering you to respond confidently during critical situations and potentially save lives. Cardiopulmonary resuscitation (CPR) is a crucial procedure used to restore blood circulation and oxygenation in cases of cardiac arrest. By understanding the principles of adult CPR and being prepared to take immediate action, you can provide vital assistance until professional medical help arrives.

The American Heart Association develops science-based CPR guidelines. The CPR steps for adults below are based on the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC):

1. Ensure Scene Safety: Check the area for safety hazards, assess the number of victims, and seek assistance from bystanders if possible.
2. Check Consciousness: Determine if the adult victim is conscious or unconscious. Tap the shoulder and ask loudly if the victim is okay.
3. Call 911: If the victim is unresponsive, call emergency services (911) and seek an AED if available.
4. Check Pulse and Breathing: Place the victim on their back, listen for breathing, and check for a pulse for 10 seconds. Respond based on pulse and breathing status.
5. Begin CPR or Rescue Breathing: Perform rescue breathing if breathing but no pulse. For no breathing and no pulse, start CPR: 30 chest compressions followed by 2 rescue breaths.
6. Chest Compressions: Place hands on the center of the chest, and compress at a rate of 100-120 compressions per minute to a depth of 2-2.4 inches.
7. Rescue Breathing: Tilt the head, pinch the nose, and give mouth-to-mouth breaths to make the chest rise.
8. Repeat Cycle: Continue 30 chest compressions and 2 rescue breaths in cycles until the victim revives or advanced medical care arrives.
9. Use AED: If available, use an AED by attaching pads, following prompts, and delivering shocks if needed.
10. Recovery Position: Place the victim in the recovery position if signs of life appear, monitor breathing, and wait for professional help.

Scene safety

In any emergency, the first step that you should follow is to check if the scene is safe. Ask how many victims are there and how the accident could have happened. See if other bystanders can assist the victims. It's also important to check the scene for factors that could harm you, such as traffic or fire.

Check for consciousness

When the scene is safe to respond to, check if the victim is conscious or unconscious. Tap the adult victim's shoulder and ask, "Are you OK?" loudly. If protective gloves or other protective equipment is available, put it on before you check the victim.

Call 911

If the victim is not responding, activate the emergency medical services by calling 911 or asking a bystander to call. If possible, ask a bystander to look for an AED machine. You can find AEDs in most offices and public buildings. If you are alone, call 911 first before performing Adult CPR.

Check for pulse and breathing and open the airway

Put the victim on their back carefully and kneel beside their chest. Listen for breathing and locate a pulse for 10 seconds. Checking the pulse and breathing of the victim will determine the actions you need to take.

• If the victim is unconscious but still breathing and has a pulse, do not perform CPR. Instead, put the victim in a recovery position and monitor the breathing. Perform CPR if the adult victim loses pulse or breathing.
• If the victim has a pulse but no breathing, give rescue breathing only. For an adult victim, the ventilation ratio is one breath every 5-6 seconds.

Begin CPR

If the victim doesn't have a pulse and no breathing, perform Adult CPR starting with 30 chest compressions, followed by two rescue breaths. You should do 5 cycles of CPR in 2 minutes.

How to perform Chest Compressions on adults?

Chest compression is a critical step in Adult CPR. To do this, place the heel of one hand between the nipple in the center of the chest (sternum). Then, place your other hand on top of that hand. Center your weight directly over your hands.

Push hard and fast to a depth of 2 - 2.4 inches or 5 - 6 centimeters at a compression rate of 100 to 120 compressions per minute until the adult victim responds.

How to perform Rescue Breathing on Adults?

To do rescue breathing or mouth-to-mouth breathing, tilt the adult victim's head back slightly and lift their chin. Pinch their nose shut, and place your mouth entirely over theirs. Then take a deep breath, and blow to make their chest rise. If their chest does not rise with the initial rescue breath, tilt their head again to open the airway before you give the 2nd breath. If the chest still doesn't rise, stop rescue breathing and do chest compressions only.

Repeat the CPR cycle

Repeat the cycle of 30 chest compressions and two rescue breathing or mouth-to-mouth breathing until the cardiac arrest victim starts breathing normally or until advanced medical care is available. If an AED or defibrillator is available, continue performing Adult CPR until the device is set up and ready to use.

Use AED if available

Turn on the machine, and attach the pads during CPR. The Automated External Defibrillator can analyze abnormal rhythm and send an electrical shock to get the heart to return to its normal rhythm.

• The device will tell you what to do, so it's essential to follow the prompts correctly.
• Deliver a shock if the AED determines one is needed.
• Do not touch the victim during the analysis or shock delivery.
• Say, "CLEAR" out loud, in a commanding voice.
• Continue CPR starting with chest compressions, whether you had to give a shock or not.

Recovery position

If the victim shows any signs of life, such as normal breathing or movements, put him in recovery position.

• Kneel on the side of the victim.
• Extend the arm closest to you at a right angle to their body, with their palm facing up.
• Take the other arm of the victim and fold it, so the back of the hand rests on the cheek nearest to you and hold it in place.
• Monitor the breathing until emergency medical services arrive to provide advanced life support.

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Understanding Adult CPR

Adult CPR refers to cardiopulmonary resuscitation performed on individuals who have experienced cardiac arrest or stopped breathing. Its purpose is to restore blood circulation and oxygenation to vital organs, particularly the brain, when the heart is not functioning effectively. Adult CPR involves chest compressions to manually pump blood and rescue breaths to provide oxygen. By initiating timely and effective CPR, bystanders can significantly increase the chances of survival until professional medical help arrives.

How old does someone have to be to receive adult CPR?

Adult CPR is performed on individuals who have gone through puberty or are around 12 years old and older. While there isn't a strict age limit, adult CPR is designed for people who are more physically developed. This is because adults have different body structures and functions compared to infants and children. It's important to consider factors like body size and growth stage when deciding which CPR techniques to use. To ensure you know how to perform CPR correctly, it's best to receive a proper CPR training course that covers the different age groups.

What is the difference between Adult and Pediatric CPR?

The main differences between Adult CPR  and pediatric CPR lie in the techniques and considerations specific to each age group. Here are the key distinctions:

• Compression depth: For adults, the recommended compression depth is about 2.4 inches (6 centimeters), while for children, it is about 2 inches (5 centimeters), and for infants, it is about 1.5 inches (4 centimeters). 
• Compression-to-ventilation ratio: In adult CPR, the ratio of compressions to ventilations is 30:2, which means 30 chest compressions followed by 2 rescue breaths. In pediatric CPR, the ratio may vary depending on the age of the child. For infants and younger children, the ratio is 15:2, and for older children, it may be 30:2 or even hands-only CPR in some cases.
• Hand placement: During adult CPR, rescuers place their both hands on the lower half of the sternum, while in pediatric CPR, rescuers may use 1 or 2 hands, depending on the age of the child. For infants, two fingers are used to compress the chest just below the nipple line.
  
  

When to use CPR on Adults?

High-quality CPR is required for any adult victim who is unresponsive or not breathing normally. Here are the circumstances that require CPR for adults:

Cardiac Arrest

Cardiac arrest occurs when the heart suddenly stops functioning effectively, leading to the interruption of blood flow to the body's vital organs. In this situation, the adult will collapse, become unresponsive, and stop breathing normally. Adult CPR should be initiated immediately to restore blood circulation and oxygenation, as every second counts in attempting to revive the person. High quality CPR helps maintain a minimal flow of oxygenated blood to the brain and other organs until advanced medical help arrives.

Unresponsiveness

If an adult is unresponsive and not breathing normally, it is crucial to start Adult CPR promptly. Unresponsiveness can result from various causes, such as respiratory failure, heart attack, or trauma. By performing CPR, chest compressions, and rescue breaths help circulate oxygenated blood throughout the body, supplying vital organs with oxygen until professional medical assistance is available.

Drowning

Drowning occurs when an adult is submerged in water and cannot breathe. If someone finds an unresponsive adult after a drowning incident, Adult CPR should be initiated immediately. The combination of chest compressions and ventilation is vital in restoring oxygenation and blood circulation, compensating for the lack of breathing that occurs during submersion. Initiating CPR promptly can make a significant difference in the adult's chances of survival.

Drug Overdose

In cases of a drug overdose, the individual may experience a life-threatening condition where their breathing becomes shallow or stops altogether. If an adult becomes unresponsive due to a drug overdose and is not breathing normally, CPR should be performed. Chest compressions help circulate the remaining oxygenated blood in the body, while ventilation provide additional oxygen to the vital organs. Prompt initiation of Adult CPR can sustain the adult's vital functions until medical professionals arrive to provide appropriate medical intervention.

Choking

Choking can lead to a complete blockage of the airway, causing an adult to become unresponsive and unable to breathe. When attempts to clear the airway are unsuccessful, and the adult remains unresponsive, CPR should be administered. By performing Adult CPR, chest compressions can create enough pressure to dislodge the obstruction and restore normal breathing. CPR serves as a critical intervention to maintain blood flow and oxygenation while additional measures are taken to address the choking incident.

How does CPR differ in an unresponsive adult choking victim?

CPR for an unresponsive adult choking victim differs from standard CPR for a cardiac arrest victim. If an adult is choking and becomes unresponsive, here's how you should respond:

1. Check for Responsiveness: Try to wake the person up by tapping and shouting. If they don't respond and you suspect they are choking, you need to act quickly.
2. Call for Help: Dial emergency services or have someone else call for help while you start providing assistance.
3. Perform Heimlich Maneuver (Abdominal Thrusts): Stand behind the person and place your arms around their waist. Make a fist with one hand and place it slightly above the navel but below the ribcage. Hold your fist with your other hand and give quick, upward abdominal thrusts. The goal is to create enough pressure to dislodge the obstructing object from the person's airway.
4. Check the Mouth: After performing abdominal thrusts, check the person's mouth to see if the object has been dislodged. If the object is visible and accessible, carefully remove it with your fingers if possible.
5. Begin CPR if Necessary: If the person becomes unresponsive after attempting the Heimlich maneuver and checking the mouth, begin CPR if you have been trained to do so. Perform chest compressions at a rate of around 100-120 compressions per minute. You may perform CPR with chest compressions only if you are not comfortable giving rescue breaths or if you suspect the victim has a high risk of infection.
6. Continue CPR and Check Airway: Continue the cycle of chest compressions and checking the airway for any signs of the object being dislodged. If you see the object, remove it. If the object is not visible, continue CPR and check the airway periodically.
7. Do Not Blindly Sweep the Airway: Unlike standard choking response guidelines, do not perform blind finger sweeps of the airway in an unresponsive choking victim. This action could potentially push the object deeper into the airway.

While performing High-quality CPR on an Adult, what action should you ensure is being accomplished?

While performing high-quality CPR on an adult, several important actions should be ensured to maximize its effectiveness:

1. Ensure that chest compressions are being performed correctly. Maintain an appropriate compression rate of 100-120 compressions per minute, ensuring that compressions are delivered consistently and without interruptions. 
2. Minimize interruptions in chest compressions as much as possible. Avoid excessive pauses or delays, as interruptions can negatively impact the effectiveness of CPR. Coordinate transitions during rescuer swaps or when preparing for other interventions.
3. Allow for full chest recoil between compressions. Allowing for complete chest recoil allows the heart to refill with blood, optimizing blood circulation during CPR.
4. While rescue breaths are important, avoid excessive ventilation. Over-ventilating can lead to complications and reduce the efficiency of chest compressions. Follow the recommended ratio of 2 rescue breaths after every 30 compressions unless trained in hands-only CPR.

By focusing on these actions, you can help maintain high-quality CPR, increase the likelihood of restoring blood circulation, and improve the chances of a positive outcome for the adult in need.

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When to seek medical attention after performing adult CPR?

After performing adult CPR, it is important to seek medical attention promptly. Even if the adult shows signs of improvement or has regained consciousness, it is crucial to have them evaluated by healthcare professionals. Medical attention ensures a thorough assessment of their condition, identifies any underlying causes or complications, and provides appropriate treatment.

If the adult does not respond to CPR or if you have performed CPR for an extended period without significant improvement, contact emergency medical services for guidance and further assistance. It is always better to seek medical attention to ensure the best possible care for the adult.

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Special Circumstances Requiring Adjustments in Adult CPR Techniques

Performing CPR on adults with special circumstances may require adjustments to the standard Adult CPR techniques. Here are some examples:

1. Pregnant: When performing CPR on a pregnant, the rescuer should position their hands slightly higher on the chest, just above the sternum, to avoid placing excessive pressure on the abdomen. It is important to maintain adequate blood circulation to both the pregnant and the fetus.
2. Adults with underlying medical conditions: Certain medical conditions, such as a pacemaker or implanted devices, may affect the placement of hands for chest compressions. In these cases, it is important to avoid placing direct pressure on the device. Adjust hand placement to ensure effective compressions while being mindful of any medical devices or conditions.
3. Chest deformities or injuries: Adults with chest deformities or injuries, such as a recent rib fracture or chest trauma, may require modifications in hand placement during chest compressions. Adjust the hand position to avoid causing additional harm while still providing effective compressions.
4. Obese: In cases where the adult is obese, additional pressure may be required during chest compressions to effectively circulate blood. Adjust hand placement and apply more force if needed, ensuring that the compressions are deep enough to facilitate blood flow.
5. Individuals in confined spaces: When performing CPR in confined spaces, such as the backseat of a car, adjustments may be necessary to accommodate the limited space. Adapt the technique by using one hand or modified hand placement for compressions, ensuring adequate depth and rate while considering the available space.

It is important to note that these adjustments should be made while maintaining the core principles of effective CPR, including compressing the chest adequately and allowing for full chest recoil.

When performing 2 rescuer CPR on an adult victim, how often should a switch take place?

In a two-rescuer CPR scenario, rescuers should switch roles every two minutes or 5 cycles of CPR to avoid fatigue and maintain the quality of compressions. This rotation allows for fatigue management and ensures that the chest compressions remain effective and uninterrupted.

Can Adult CPR be effective without rescue breaths?

Hands-only CPR or CPR without rescue breaths can still be effective in certain situations. Hands-only CPR is particularly recommended for untrained individuals or those who are unwilling or unable to provide ventilations. The emphasis in hands-only CPR is on delivering high-quality chest compressions, which help maintain blood circulation and oxygenation.

Hands-only CPR can still be lifesaving, as effective chest compressions alone can provide a certain level of oxygenation until professional medical help arrives. However, in cases of drowning, drug overdose, or other situations where oxygen deprivation is a concern, the inclusion of rescue breaths is beneficial for optimal outcomes. It's important to note that CPR guidelines may vary based on the specific circumstances and any available training or professional guidance.

Risks and Complications Associated with Adult CPR

While Adult CPR is a life-saving technique, there are certain risks and potential complications associated with its administration. It's important to be aware of these factors. Here are some considerations:

• Rib fractures or injuries: The force applied during chest compressions can occasionally result in rib fractures or injuries. This is more common in older individuals or those with fragile bones. While this is a potential complication, it is considered a secondary concern compared to the urgency of performing Adult CPR to restore circulation and oxygenation.
• Internal organ damage: In rare cases, the force exerted during chest compressions may cause damage to internal organs, such as the liver or lungs. However, the risk of organ damage is outweighed by the potential benefits of Adult CPR in saving a person's life.
• Vomiting: During Adult CPR, particularly when providing rescue breaths, there is a risk of the person vomiting. This can potentially lead to airway obstruction or aspiration. If vomiting occurs, the rescuer should carefully turn the person onto their side, clear the airway, and resume Adult CPR.
• Fatigue and rescuer swap delays: Performing Adult CPR can be physically demanding, leading to fatigue for the lay rescuers. Fatigue may affect the quality of chest compressions. It is crucial to switch rescuers every two minutes or after about five cycles of CPR to manage fatigue effectively and maintain the effectiveness of compressions.

It's important to understand that the risks and complications associated with Adult CPR are outweighed by the potential benefits of sustaining life during a cardiac arrest or life-threatening situation.

CPR training and certification can equip individuals with the knowledge and skills to minimize risks and maximize the chances of a positive outcome.