What are the CPR Steps

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The basic CPR steps below are based on the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care:

  1. Check the scene and the victim. Make sure it is safe to approach the victim and that there is no danger to you or others. Also, check to see if the victim is unresponsive.
  2. Call 911. If the victim is unresponsive, call 911 before beginning CPR.
  3. Check for breathing and open airway. Position the victim on their back on a firm surface and check the breathing for 10 seconds. If possible, tilt the head back and lift the chin to open the airway.
  4. Begin CPR starting with chest compressions. Place your hands on the victim's chest, interlocking your fingers. Use your body weight to perform chest compressions at a rate of 100-120 compressions per minute.
  5. After 30 chest compressions, give two breaths. Then, open the airway and provide rescue breath for about 1 second to make their chest rise.
  6. Repeat the CPR cycle. Continue giving 30 chest compressions and two rescue breaths.
  7. Use AED if available. Turn on the machine, and attach the pads during CPR. An automated External Defibrillator can analyze abnormal heart rhythms and send an electrical shock to get the heart to return to its normal rhythm.
  8. Put the victim in the recovery position.

Key Takeaway

  • Call 911 immediately if the victim is not responding.
  • If the victim has a pulse but no breathing, give rescue breathing only.
  • Recheck the breathing and pulse after every 2 minutes.
  • The correct compression rate for Adults, Children, and Infant is 100 to 120 compressions per minute (about the same beat as "Stayin' Alive" by Bee Gees)
  • Compression depth for Adults and Children is 2 inches. For infants, at least one-third of the diameter of the chest (about 1½ inches)
  • If an Automated External Defibrillator is available, continue CPR until the device is ready to use.
  • If you don't have formal training in CPR or you are not comfortable giving rescue breaths, and you see a child or adult suddenly collapse, perform hands-only CPR.
  • When the victim regains consciousness, monitor the breathing until emergency medical services arrive to provide advanced life support.
  • CPR training providers and organizations like American Heart Association offer CPR and First Aid training courses in-person, online, or blended learning if you are interested in getting certified in CPR.

Contents

Why is Cardiopulmonary Resuscitation Important?

CPR is necessary because it keeps oxygen-rich blood flow to the victim's brain and vital organs until advanced treatment is available. There is usually enough oxygen to keep the vital organs alive, but it's only supported for a few minutes. After that, it will not circulate unless someone performs CPR.

Knowing basic emergency first aid and CPR is essential because it can double or triple the victim's chance of survival. Keeping the blood flow active allows for successful resuscitation. Although there is no guarantee that the victim will survive CPR, it does give them a chance when otherwise, there would have been none. Without CPR, it only takes a few minutes for the victim's brain to become injured due to a lack of oxygen.

What are the 2 Types of CPR?

  1. Standard CPR with rescue breaths - Involves chest compressions with rescue breaths at a ratio of 30:2 compressions to ventilation. Standard CPR can provide more oxygen to the body before the paramedics arrive. Healthcare providers and individuals with CPR training can only do it.
    Studies have shown that a combination of chest compressions and rescue breaths is most effective, especially for children and infants who experience cardiac arrest due to hypoxia or severe lack of oxygen. In addition, other underlying causes of cardiac arrests, such as drowning, trauma, drug overdose, and other noncardiac causes, will benefit from breaths and compressions.
  2. Hands-only CPR - Also known as compressions-only CPR, hands-only CPR involves calling for help and doing continuous and uninterrupted chest compressions in a rapid motion. Hands-only CPR can be performed by the general public or bystanders who witness an out-of-hospital cardiac arrest. It can prevent a delay in getting the blood moving through the body.

What is the ABC or CAB in CPR?

The ABCs in CPR are abbreviations for Airway, Breathing, and Compressions. It refers to the correct sequence of CPR. The ABC steps ensure that the victim receives proper CPR within the shortest time possible.

However, based on the latest guidelines of the American Heart Association, the correct order for CPR is now the C-A-B Steps or Compression, Airway, and Breathing. This is because cardiac arrest victims can go a minute or two without taking a breath. What cardiac arrest victims need is for that blood to get flowing again, which can be achieved through chest compressions.

When to use CPR on Adults, Children, and Infant?

Adult: CPR is needed when an adult is unresponsive and not breathing.

Child and Infant: CPR is needed when an infant or child is unresponsive and not breathing normally or not breathing at all.

An adult or child might need CPR if they stop breathing in any of the following circumstances:

  • Out of hospital cardiac emergency
  • Choking
  • Road traffic accident
  • Near-drowning
  • Suffocation
  • Poisoning
  • Drug overdose
  • Alcohol overdose
  • Smoke inhalation
  • Electrocution
  • Suspected sudden infant death syndrome

What Should You Do If a Victim is Unconscious and Needs CPR?

If you are CPR certified, check to see if the victim has a pulse and is breathing. If there is no pulse but the victim is breathing inadequately, provide 30 chest compressions at a rate of 100 to 120 compressions per minute, followed by two rescue breaths.

If you are not trained, or if you are not confident in giving rescue breaths, perform uninterrupted chest compressions at a rate of 100 to 120 per minute until the Emergency Medical Team takes over to provide advanced life support or if the person becomes responsive.

How to Perform CPR Steps for Adults?

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).

Step 1. 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.

Step 2: Check for consciousness.

When the scene is safe to respond to, check if the victim is conscious or unconscious. Tap the 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.

Step 3. 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 CPR.

Step 4. Check for pulse and breathing and open the airway

Put the victim on their back carefully and kneel beside their chest. Then, place your ear next to the victim's mouth and listen 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 needed.
  • 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.
  • If the victim doesn't have a pulse and no breathing, give CPR starting with 30 chest compressions, followed by two rescue breaths.
  • Recheck the breathing and pulse after every 2 minutes. If there is still a pulse but no breathing, continue ventilations. If there is still no breathing and no pulse, begin CPR.
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Step 5. Begin CPR

How to perform Chest Compressions on adults?

Chest compression is a critical step in 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 at least two inches at a rate of 100 to 120 compressions per minute until the victim responds. Your hands shouldn't bounce, but you should lift your entire body weight off the patient between each compression.

How to perform Rescue Breathing on Adults?

To do rescue breathing or mouth-to-mouth breathing, tilt the victim's head back slightly and lift their chin. Next, pinch their nose shut, place your mouth entirely over theirs, 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.

Step 6. Repeat the cycle

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

Step 7. 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.

Look closely at the images on the pads. 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.

Step 7. Put the victim in the 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.

What are the CPR Steps for a Child?

The CPR procedure for children between 1 and 8 years old is the same as for adults.

Step 1. Scene safety

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.

Step 2: Check for consciousness.

When the scene is safe to respond to, check if the child victim is conscious or unconscious. Tap the victim's shoulder and ask, "Are you OK?" loudly. If protective gloves are available, wear them before you check the victim.

Step 3. Call 911

If the child is not responding, activate the emergency medical services by calling 911immediately or ask a bystander to call and search for an AED machine. You can find AEDs in most offices and public buildings.

If you are alone and the collapse is unwitnessed, perform 2 minutes of CPR before calling 911 to increase the child's chances of survival. However, if you're alone and have witnessed the collapse, call 911 before performing CPR.

Step 4. Check for pulse and breathing

Put the child on their back carefully and kneel beside their chest. Then, place your ear next to the victim's mouth and listen for 10 seconds. Checking the pulse and breathing of the victim will determine the actions you need to take.

  • If the child 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 needed.
  • If the child has a pulse but no breathing, give rescue breathing only. For a child victim, the ventilation ratio is one breath every 3-5 seconds.
  • If the child doesn't have a pulse and no breathing, give CPR starting with 30 chest compressions, followed by two rescue breaths. If there are two rescuers, the CPR ratio will be 15 compressions to 2 breaths.
  • Recheck the breathing and pulse after every 2 minutes. If there is still a pulse but no breathing, continue ventilations. If there is still no breathing and no pulse, begin CPR.

Step. 5 Begin CPR

Place two hands (or one hand if the child is tiny) on the child's sternum. Push hard and fast to a depth of at least two inches until the child responds. Your hands shouldn't bounce, but you should lift your entire body weight off the patient between each compression.

If you are comfortable giving rescue breathing, pinch the nose shut and make a complete seal over the child's mouth and deliver two rescue breaths.

Step 5. Repeat the cycle

Repeat the CPR cycles of chest compressions and rescue breathing until advanced medical care from the emergency medical services is available or when the child shows signs of life.

Step 6. If AED is Available

If available, the rescuer should use child pads when using an AED. Some AED units may have a child key or switch on the AED. If the child is tiny, you may need to put one pad on the center of the chest and the other on the child's back to avoid having them touch. Use adult pads if child pads are not available.

Child pads lower the amount of energy delivered compared to adult pads. However, if child pads are unavailable, adult pads may be used since providing a shock is better than no shock.

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How to Perform CPR on Infant?

Step 1. Scene safety

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.

Step 2: Check for consciousness.

When the scene is safe to respond to, check if the child victim is conscious or unconscious. Flick the bottom of the infant's foot to elicit a response. This takes the place of tapping the shoulder of an older person. If protective gloves are available, wear them before you check the victim.

Step 3. Call 911

If there is no response from the infant, ask a bystander to call 911. If you are alone and the collapse is unwitnessed, perform 2 minutes of CPR before calling 911 to increase the child's chances of survival. However, if you're alone and have witnessed the collapse, call 911 before performing CPR.

Step 4. Check for pulse and breathing

Carefully put the baby on their back and kneel beside their chest. Then, place your ear next to the victim's mouth and listen for 10 seconds. Checking the pulse and breathing will determine the actions that you need to take.

  • If the infant 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 needed.
  • If the infant has a pulse but no breathing, give rescue breathing only. For infants, the ventilation ratio is 1 breath every 3- 5 seconds.
  • If the infant doesn't have a pulse and no breathing, give CPR starting with 30 chest compressions, followed by 2 rescue breaths. If there are 2 rescuers, the CPR ratio will be 15 compressions to 2 breaths.
  • Recheck the breathing and pulse after every 2 minutes. If there is still a pulse but no breathing, continue ventilations. If there is still no breathing and no pulse, begin CPR.

Step 5. Begin CPR

How to perform chest compressions on an infant?

To perform CPR on a baby under the age of 1, place two fingers of your one hand in the center of the infant's chest. Gently use your fingers to compress the chest about 1.5 inches deep, at a rate of 100 compressions per minute, just as you would when giving an adult CPR. Allow the chest to fully recoil after each compression.

How to perform rescue breathing on an infant?

If you are comfortable giving rescue breathing to a baby, give two rescue breaths between each series of 30 chest compressions, just as you would with an older person. Create a proper seal by covering the infant's nose and mouth through your mouth. Give a gentle puff of air for 1 second, and watch to see if the baby's chest rises.

Using a bag-mask device or other barrier devices when giving rescue breaths to children and infants is recommended but not required by the American Heart Association.

Step 6. Repeat.

Repeat the CPR steps by giving 30 chest compressions and two rescue breaths until the emergency medical services arrive or when the infant shows any apparent signs of life.

High-Quality CPR

A continued emphasis on good and effective CPR results in better outcomes and survival rates. High-quality CPR means:

Pushing hard and fast: Forceful, fast compressions will provide better circulation of blood and oxygen. Quick compressions mean at least 100-120 compressions per minute.

Allowing for full chest recoil after each compression: Relaxing the pressure on the chest between compressions allows the heart to refill and pump more blood.

Minimizing interruption in chest compressions: The blood flow stops if there's an interruption between chest compressions.

Early defibrillation: All victims have a better chance of surviving when CPR is performed in combination with early defibrillation.

What Each Step of CPR Does?

Each step of CPR serves a vital purpose. Here's what each step does:

Asking If the Person Is OK: It's essential to ensure the person needs CPR. If the person is responsive, don't start CPR, but get medical help immediately, especially if they seem confused or unable to speak.

Calling 911: The patient must be taken to the hospital by ambulance as soon as possible.

Chest Compressions: Chest compression moves blood through the brain, keeping it working until the heart can start again.

Rescue Breathing: This CPR step is still debatable whether it's necessary. Nevertheless, if you perform rescue breaths, ensure you know how to do it correctly.

How long is the CPR cycle?

2 minutes. For CPR to be effective, rescuers should perform five cycles in two minutes. Additionally, it's recommended that rescuers swap after two minutes and five cycles to prevent exhaustion and maintain effective compressions.

How do you do CPR on the elderly?

The elderly do not have the type of heart rhythm that responds to CPR. In addition, any chronic disease affecting the heart, lungs, brain, and kidneys can lower the chances of survival after cardiac arrest. CPR survival will be even lower if a person has multiple advanced chronic illnesses.

How to Perform Hands-Only CPR?

The American Heart Association recommends performing hands-only CPR for those not trained in CPR. So if you don't have formal training in CPR or you are not comfortable giving rescue breaths, and you see a child or adult suddenly collapse, call 911 and perform chest compressions only. Push hard and fast in the center of the chest to the beat of the song "Stayin' Alive." CPR can double a person's chances of survival, and "Stayin' Alive" has the right beat for Hands-Only CPR."

When Should CPR be stopped?

Once you begin CPR, do not stop except in one of these situations:

  1. The victim shows apparent signs of life, such as movement or breathing.
  2. An AED is available and ready to use.
  3. Another trained responder or EMS personnel takes over to provide advanced life support.
  4. You are too exhausted to continue.
  5. The scene becomes unsafe.

Conclusion

CPR is a critical skill that can mean the difference between life and death for thousands of people experiencing cardiac or respiratory arrest. With the help of basic steps in CPR, the chances of survival triples if the victim suffers a heart attack, cardiac emergency, or other life-threatening emergencies before the emergency services team, arrives. The emergency procedure and CPR Steps will depend on whether the victim is an infant, child, or adult.

If you want to learn how to perform CPR correctly, it's essential that you take an accredited first-aid training course that covers Cardiopulmonary Resuscitation and how to use Automated External Defibrillator. CPR training providers and organizations like American Heart Association offer CPR and First Aid training courses in-person, online, or blended learning if you are interested in getting certified in CPR. CPR classes are typically completed in 1 hour, depending on which format you choose. Once you have completed the CPR class, you will be able to get a certificate that will allow you to respond to a wide range of medical emergencies.

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