Chapter 5CPR

Heart Attack and Cardiac Arrest

• Heart attack occurs when heart muscle tissue dies because its blood supply is severely reduced or stopped.

• Cardiac arrest results when the heart stops beating.

Caring for Cardiac Arrest

• Chain of survival: Five events that must occur rapidly and in an integrated manner during cardiac arrest

Reprinted with permission. 2015 American Heart Association Guidelines: Update for CPR and ECC. Part 4: Systems of Care & Continuous Quality Improvement. Circulation. 2015; 132:S397-S413. © 2015, American Heart Association, Inc.

Purpose of CPR

• CPR moves blood to the heart and brain by giving chest compressions.

• CPR provides periodic breaths to place oxygen into the person’s lungs.

Age Classifications

• Adults: Puberty and older• Children: 1 year to puberty• Infants: Younger than 1 year

Check for Responsiveness

• Tap the person’s shoulder and ask if he or she is okay.

• If the person does not respond, he or she is said to be unresponsive.

Activate the EMS System

• Call or ask a bystander to call 9-1-1.− If a mobile phone is used, it should be kept by

the person’s side.− If a mobile phone is not available, leave the

person to call 9-1-1 and get an AED.• If alone with a child or infant, give CPR for

five cycles, and then call 9-1-1.

Check for Breathing

• Check breathing for 5 to 10 seconds by looking for the rise and fall of the person’s chest.

Give Chest Compressions

• Perform on a firm, flat surface whenever possible.

• For an adult:− Use two hands.− Compress at least

2 inches.

• For a child:− Use one or two

hands.− Compress about 2

inches.• For an infant:

− Use two fingers.− Compress about 1.5

inches.

Give Chest Compressions

• Place hands in the center of the chest.• Give 100 to 120 compressions per minute

(speed not rate).

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Open the Airway

• Use the head tilt–chin lift maneuver.• Place one hand on the person’s forehead

and the fingertips of the other hand on the bony part of the chin.

• Lift the chin upward to help tilt the person’s head back.

Give Rescue Breaths

• Keep the person’s airway open using the head tilt–chin lift maneuver.

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Give Rescue Breaths

• Pinch the person’s nose shut.• Take a normal breath, and blow into the

person’s mouth for one (1) second.• Take a breath for yourself.• Give another 1-second breath.

Continue CPR Until…

• An automated external defibrillator (AED) is available.

• Person shows signs of life.• Emergency medical services (EMS)

personnel take over.• You become too tired to continue.

Methods of Rescue Breathing

• Mouth-to-mouth breathing• Mouth-to-mask breathing• Mouth-to-face shield breathing

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Adult and Child CPR

• Check for responsiveness.• Activate EMS.• Breathing?

− Observe chest for movement.

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Adult and Child CPR

• Provide chest compressions hard and fast.• Open airway.• Give two rescue breaths.

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Adult and Child CPR

• Repeat compression and breath cycles until an AED arrives.

• Use an AED as soon as it arrives.

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Infant CPR

• Check for responsiveness.• Activate EMS.

− If you are alone, give 5 sets of CPR first.• Check for breathing.

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Infant CPR

• Give chest compressions.• Open the airway.• Give two rescue breaths.

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Recognizing Airway Obstruction

• Mild obstruction− Good air exchange − Forceful coughing

efforts− Person should be

encouraged to cough.

• Severe obstruction− Poor air exchange− Breathing difficulty− Weak and

ineffective cough− Inability to speak or

breath− Cyanosis

Adult and Child Choking• Ask, “Are you

choking?”• If the person nods

yes, provide care.

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Adult and Child Choking• Perform the

Heimlich maneuver by moving behind the person.

• Reach around the person’s waist with both arms and locate the navel.

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Adult and Child Choking• Place a fist with the

thumb side against the person’s abdomen, just above the navel.

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Adult and Child Choking• Grasp the fist with

your other hand.• Press into the abdomen

with quick, inward and upward thrusts.

• Continue until the object is removed or the person becomes unresponsive.

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Infant Choking• Support the infant’s head and neck.• Lay the infant face down on the forearm.• Lower the arm to the leg. • Give five back blows

between the shoulder blades with the heel of the hand.

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Infant Choking• Roll the infant face up.• Give five chest compressions on the

infant’s sternum using two fingers.• Repeat until the object

is removed or the infant becomes unresponsive.

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If a Person Becomes Unresponsive…

• Immediately call 9-1-1.• Begin CPR.• Look for an object in the person’s mouth

during CPR.