Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).
Assessing Responsiveness and Checking the Carotid Pulse
When approaching an unresponsive person, first ensure the scene is safe. Then, check for responsiveness by tapping the individual and calling their name. If there is no response, quickly assess their breathing and check for a carotid pulse.
To locate the carotid pulse:
Place index and middle fingers on the side of the neck, beside the windpipe, in the groove between the neck muscles and trachea.
This area is located below the jawline and slightly toward the side of the neck.
Check for the pulse for no longer than 10 seconds to avoid delays in starting chest compressions if necessary.
Starting Chest Compressions
If the carotid pulse is absent and the person is not breathing, this indicates cardiac arrest, and chest compressions must begin immediately. Place the heel of a hand on the center of the chest, the lower half of the sternum, and the other hand on top. Initiate chest compressions at a rate of 100-120 per minute, pressing the chest to a depth of 2 to 2.4 inches. Proper technique includes allowing complete chest recoil between compressions to ensure adequate blood flow.
Rescue Breaths
Before delivering rescue breaths, open the airway using the head tilt-chin lift technique: Place one hand on the person’s forehead and gently tilt the head back. Use two fingers of the other hand to lift the chin, opening the airway. After every 30 compressions, deliver two rescue breaths, ensuring each breath lasts 1 second and causes the chest to rise visibly, indicating adequate ventilation. Avoid over-ventilation, as it can reduce the effectiveness of CPR.
Using an Automated External Defibrillator (AED)
If an AED is available, it should be used as soon as possible. Follow the device's prompts and deliver a shock if advised. Chest compressions should resume immediately after the shock is delivered without reassessing the pulse until the AED instructs otherwise. Continue providing 30 chest compressions followed by two rescue breaths until advanced medical help arrives or the patient shows signs of recovery.
Rescue Breathing with a Pulse
In cases where a carotid pulse is present but the patient is not breathing, rescue breathing should be administered at one breath every 5 to 6 seconds, with periodic pulse checks to confirm ongoing circulation.
High-Quality CPR Key Elements
High-quality CPR is essential for increasing survival rates in cardiac arrest. Effective CPR includes minimizing interruptions in chest compressions, ensuring full chest recoil after each compression, and delivering compressions at the correct depth and rate. Properly assessing whether a pulse is present or absent is crucial for guiding the resuscitation process and ensuring appropriate intervention for cardiac arrest. Calling for emergency medical services early in the process is equally important, as prompt access to care and AED use significantly improve outcomes in cardiac arrest cases.
Cardiopulmonary resuscitation, or CPR, is an emergency technique to maintain blood flow during cardiac arrest.
In Basic Life Support, CPR follows the CAB sequence: circulation, airway, and breathing.
If an adult is not breathing normally and is unresponsive, tap their shoulder and ask, “Are you okay?” Activate emergency services and check the carotid pulse for no more than 10 seconds.
If no pulse is found, initiate chest compressions by placing the base of one hand on the lower sternum with the other hand on top.
Perform compressions at a rate of 100-120 per minute, at least 2 inches deep. After 30 compressions, open the airway with the head-tilt chin-lift technique and give two breaths.
If an advanced airway is in place, continue compressions without pausing and give one breath every 6 seconds.
When a pulse is present but the person is not breathing, provide one rescue breath every 6 seconds, ensuring the chest rises with each breath. Also, recheck the pulse every 2 minutes, ensuring that the pulse check takes no longer than 10 seconds.
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