Performing Cardiopulmonary Resuscitation (CPR)

Goal: CPR is performed effectively without adverse effect to the patient.

1. Assess responsiveness. If the patient is not responsive, call for help, pull call bell, and call the facility emergency response number. Call for the automated external defibrillator (AED).

2. Put on gloves, if available. Position the patient supine on his or her back on a firm, flat surface, with arms alongside the body. If the patient is in bed, place a backboard or other rigid surface under the patient (often the footboard of the patient’s bed).

3. Use the head tilt–chin lift maneuver to open the airway. Place one hand on the victim’s forehead and apply firm, backward pressure with the palm to tilt the head back. Place the fingers of the other hand under the bony part of the lower jaw near the chin and lift the jaw upward to bring the chin forward and the teeth almost to occlusion. If trauma to the head or neck is present or suspected, use the jaw-thrust maneuver to open the airway. Place one hand on each side of the patient’s head. Rest elbows on the flat surface under the patient, grasp the angle of the patient’s lower jaw, and lift with both hands.

4. Look, listen, and feel for air exchange. Take at least 5 seconds and no more than 10 seconds (AHA, 2006).

5. If the patient resumes breathing or adequate respirations and signs of circulation are noted, place the patient in the recovery position.

6. If no spontaneous breathing is noted, seal the patient’s mouth and nose with the face shield, one-way valve mask, or Ambu-bag (handheld resuscitation bag), if available. If not available, seal the patient’s mouth with rescuer’s mouth.

7. Instill two breaths, each lasting 1 second, making the chest rise.

8. If you are unable to ventilate or the chest does not rise during ventilation, reposition the patient’s head and reattempt to ventilate. If still unable to ventilate, begin CPR. Each subsequent time the airway is opened to administer breaths, look for an object. If an object is visible in the mouth, remove it. If no object is visible, continue with CPR.

9. Check the carotid pulse, simultaneously evaluating for breathing, coughing, or movement. This assessment should take at least 5 seconds and no more than 10 seconds. Place the patient in the recovery position if breathing resumes.

10. If patient has a pulse, but remains without spontaneous breathing, continue rescue breathing at a rate of one breath every 5 to 6 seconds, for a rate of 10 to 12 breaths per minute.

11. If the patient is without signs of circulation, position the heel of one hand in the center of the chest between the nipples, directly over the lower half of the sternum. Place the other hand directly on top of the first hand. Extend or interlace fingers to keep fingers above the chest. Straighten arms and position shoulders directly over hands.

12. Perform 30 chest compressions at a rate of 100 per minute, counting “one, two, etc.” up to 30, keeping elbows locked, arms straight, and shoulders directly over the hands. Chest compressions should depress the sternum 11⁄2 to 2 inches. Push straight down on the patient’s sternum. Allow full chest recoil (re-expand) after each compression.

13. Give two rescue breaths after each set of 30 compressions. Do five complete cycles of 30 compressions and two ventilations.

14. Defibrillation should be provided at the earliest possible moment, as soon as AED becomes available. Refer to Skill 16-6: Automated External Defibrillation and Skill 16-7: Manual External Defibrillation.

15. Continue CPR until advanced care providers take over, the patient starts to move, you are too exhausted to continue, or a physician discontinues CPR. Advanced care providers will indicate when a pulse check or other therapies are appropriate (AHA, 2006,).

16. Remove gloves, if used. Perform hand hygiene.