Adult CPR, AED and Choking

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CPR is a vital and an essential skill that can save someone’s life. The two key elements of CPR are pressing on the chest, also called compressions, and providing breaths. Any child past puberty is treated with adult CPR. Young children and infants require special considerations for CPR.

Adult CPR

CPR is comprised of chest compressions, airway management, and rescue breathing. To deliver high-quality CPR, you must begin high-quality chest compressions quickly, as these are considered the most important factor in giving the person a chance to recover. Compressing the chest circulates blood to the brain and the heart. High-quality chest compressions are delivered at a rate between 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm).

When the person is unresponsive and is not breathing or only gasping for air, provide CPR.

2017 updates recommend for adults in out-of-hospital cardiac arrest (OHCA), that untrained lay rescuers should provide chest compression only CPR with or without dispatcher assistance. For lay rescuers trained in chest compression only CPR, it is recommended that they provide chest compression only CPR for adults in CPR. For lay rescuers trained in CPR using chest compressions and ventilation, rescue breaths, it is reasonable to provide ventilation, rescue breaths, and chest compressions for the adult in OHCA.

For adult CPR, do the following:

  1. Make sure the scene and area around the person is safe.
  2. Tap the person and talk loudly: “Are you okay?”
  3. Yell for help. Use a cellphone to call 911 and send a bystander to get an AED.
  4. Check the person’s breathing.
  5. If the person is not responding, breathing, or only gasping, start CPR.
  6. Give 30 compressions at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm). Let the chest rise back up before you start your next compression.
  7. Open the airway and give two breaths.

Continue giving compressions and breaths until the AED arrives, until advanced help arrives and
assumes care, or until the person begins to respond.

Take Note

As a rescuer, if you are untrained in CPR, then give the “hands-only” CPR. The “hands-only” CPR is when you give continuous compressions but no breaths.

Adult CPR Chest Compressions
Adult CPR Chest Compressions
Adult CPR Chest Compressions

Figure 14

Compressions

Chest compressions have the greatest impact for survival. Many rescuers fail to push hard or fast enough. High-quality chest compressions have the greatest chance to save a life.

Chest compressions should always be given at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm). Compressing the chest slower than 100 beats per minute is less likely to provide enough circulation to the brain, heart, and other vital organs, while compressing faster than 120 beats per minute does not provide enough time for the heart to fill between each compression, which will reduce output as well. Similarly, pressing the chest deeper than 2.4 inches (6 cm) increases the risk of injuring the person, while not pressing deep enough will not squeeze the heart enough to provide adequate blood flow.

CPR always begins with compressions before administering breaths. Rescuers who are uncomfortable performing mouth-to-mouth and do not have a mask may perform hands-only CPR and give compressions at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm).

For chest compressions, do the following:

  1. Position the person on their back on a firm, flat surface.
  2. Remove or open up clothing at the neck and chest area.
  3. Feel for the end of the breastbone (sternum). (Figure 14a)
  4. Place the heel of one hand on the lower half of the breastbone. Avoid pressing down on the very end of the breastbone as the bony tip, called the xyphoid process, may break off and slash the liver, resulting in internal bleeding. Put the other hand on top of the first. (Figure 14b)
  5. Press straight down at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm). (Figure 14c)
  6. Let the chest recoil completely between compressions. Your hands should remain in contact with the person, without bouncing or leaning on the person.

Performing proper CPR is often tiring. Ask to switch positions when tired if another rescuer is
available to help. Monitor each other’s performance, providing encouragement and offering to switch
when fatigue sets in.

Giving Breaths

Giving breaths during CPR can help maintain a supply of oxygen in the lungs. Oxygen, in turn, is circulated to the brain and to the vital organs by chest compressions. The preferred method is to use a mask; however, mouth-to-mouth can also be performed. A correctly executed breath will cause the person’s chest to rise.

To open the person’s airway, do the following:

  1. Put one hand on their forehead (Figure 15a).
  2. Place your fingers on the bony part of their chin (Figure 15b).
  3. Gently tilt the head back while lifting the chin (Figure 15c).

Now you are ready to give breaths.
Do the following:

  1. Hold the person’s airway open as described above and pinch their nose shut (Figure 15d).
  2. Take a deep breath and seal your mouth around the person’s mouth (Figure 15e).
  3. Blow into their mouth for one second and watch their chest rise.
  4. Repeat with a second breath.
CPR - Giving Breaths
CPR - Giving Breaths
CPR - Giving Breaths
CPR - Giving Breaths
CPR - Giving Breaths

Figure 15

If the chest does not rise, reposition the airway. Let their head go back to a normal position and repeat the head-tilt/chin-lift maneuver. Then give another breath and look for the chest to rise.

Perform the chest compressions without interruption. It should take no longer than 10 seconds to give two breaths. If the person’s chest fails to rise within 10 seconds, begin chest compressions again.

Mask Use

CPR, including giving breaths, is generally safe. If a mask is available, it should be used. The mask fits over the victim’s mouth and nose. Most masks have a pointed end, which should go over the bridge of the person’s nose.

When using a mask to give breaths,
do the following:

  1. Place the mask over the person’s mouth and nose (Figure 16a).
  2. Open their airway by performing the head-tilt/ chin-lift maneuver.
  3. Ensure a good seal between the mask and the person’s face.
  4. Give a breath for over one second and watch the chest rise. (Figure 16b)
  5. Deliver the second breath.
CPR Mask A
CPR Mask B

Figure 16

AED for Adults

When the heart does not work properly, a person may collapse. An AED can deliver a shock to help restart the heart. These portable units have a computer that analyzes the heart rhythm and determines if a shock is needed. Starting CPR immediately and quickly using an AED improves the chances of survival.

The AED is very simple to use. Follow the diagram or voice instructions given by the AED. Apply the pads properly and let the computer determine if and when a shock is needed. Make sure no one is touching the person if the AED advises you to push the shock button. If an AED is not quickly available, begin CPR and send someone to locate an AED.

An AED should be used anytime a person collapses, fails to respond and is only gasping, or barely breathing. Turn on the AED and then follow the prompts you see and hear.

AED - Adults A
AED - Adults B
AED - Adults C
AED - Adults D

Figure 17

To use an AED, do the following

  1. Turn the power on.
  2. Expose the chest (Figure 17a).
  3. Apply pads on the victim (Figure 17b).
  4. Connect the pads.
  5. Clear the person (Figure 17c).
  6. Analyze the rhythm.
  7. Follow the prompts (Figure 17d): Shock Advised, No Shock Advised, Check Connection, etc.
  8. Resume CPR with compressions.
Take Note

If a person has a medication patch on their chest, remove it before applying the AED pads. Also, if there is a bulge under the skin of their chest, a pacemaker may be present. Avoid placing the AED pads over this device and adjust placement accordingly. If the AED malfunctions or does not work, continue performing CPR until additional help arrives.

Activating EMS (Calling 911)

When encountering a person who is unresponsive, barely breathing, or not breathing quickly, call 911. Immediate activation of EMS by dialing 911 or the appropriate emergency number is the first step in the Chain of Survival. When available, use of a cellular phone may allow activation of EMS without leaving the person. Many cellular phones incorporate a speakerphone function, which allows a lone rescuer to communicate with the 911 operator while delivering care to the person.

In situations where a cell phone is not available, it is preferred to send a second rescuer or a bystander to call 911, so the injured/ill person is not left alone. That second rescuer or bystander may also retrieve an AED and/or a first aid kit.

Always make sure the scene is safe when approaching an injured/ill person. If you become injured or disabled, you will be unable to help the person and will become a second person to be taken care of by rescuers.

Tap the person and talk loudly: “Are you okay?” If they fail to respond or react, they are considered unresponsive. Yell for help and send somebody to call 911 and get an AED if possible.

Stay on the phone until the 911 operator tells you it is okay to hang up. The operator can help you make decisions and will not delay the arrival of additional help.

After determining that the person is unresponsive, check their breathing. If they are barely breathing or only gasping, begin CPR. Gasping may be forceful or weak, but it is generally ineffective. This is an abnormal sign and often occurs in cardiac arrest. In this situation, immediately begin CPR.

If the person is breathing normally but not responding, roll them onto their side. This can help keep their airway open and prevent them from choking on vomit. You need to monitor their breathing and be prepared to start CPR if their condition worsens.

Choking in Adults

Choking is a preventable cause of death that occurs when food or another object gets stuck in the throat. The airway gets blocked and immediate action is needed. The person typically only has a few minutes before they pass out. The universal sign of choking is holding the neck with one orboth hands.

Choking can be mild or severe. Table 1 will help determine whether it is mild or severe.

Degree of Obstruction Responsiveness Rescuers Actions
Mild Obstruction
  • Breathing but may also be wheezing
  • Coughing and making noise
  • Stay with the person, try to keep them calm
  • Encourage them to cough
  • Call 911 if the person does not clear the obstruction or seems to be getting worse
Severe Obstruction
  • Clutching the neck (universal sign of chocking)
  • Weak or no cough
  • Unable to make noise or talk; may make high-pitched noise
  • Little or no breathing
  • Appears cyanotic (blue around lips and fingertips)
  • Use abdominal thrusts (Heimlich maneuver) to attempt to remove obstruction
  • Call 911
  • Begin CPR if person becomes unresponsive

Table 1

Relief of Choking - Heimlich Maneuver - A
Relief of Choking - Heimlich Maneuver - B
Relief of Choking - Heimlich Maneuver - C

Figure 18:
Heimlich Maneuver

Relief of Choking

Abdominal Thrusts (Heimlich Maneuver)

The Heimlich maneuver is used on adolescents and adults.

To perform the Heimlich maneuver, do the following:

  1. Stand behind the person and wrap your arms around their waist under the ribcage (Figure 18a).
  2. Put your fist above the person’s navel in the middle of the belly (Figure 18b).
  3. With your other hand, hold the first fist and press forcefully into the abdomen and up toward their chest (Figure 18c).
  4. Continue performing thrusts until the obstruction is relieved or until the person becomes unresponsive. If the person becomes unresponsive, begin CPR.

Very large persons or pregnant women can be treated with chest thrusts. In this case, do the following:

Wrap both arms around the person, similar to the Heimlich maneuver. Pull your arms straight back to
deliver the chest thrusts. If a person has passed out due to choking, help them to the ground. Use the
heel of one hand to perform abdominal thrusts above the navel. Continue this until the food or object
comes out or until advanced help arrives.

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