Cardiopulmonary Resuscitation: A Study Guide for CPR/AED Class

Chapter 1: What is CPR?

CPR is a specific sequence of activities replicating the heart's pumping and breathing of the lungs to carry oxygen throughout the body. Although CPR is unlikely to restart a stopped heart, it will maintain blood flow to the victim's brain until advanced lifesaving techniques are available.

Chest Compressions: This procedure replicates the heart's pumping action from the outside. Once high-quality chest compressions are administered, the blood moves to the body's vital parts. Current protocols emphasize hands-only CPR if only one rescuer is present. This technique involves only chest compressions without artificial breathing.

Rescue Breathing: During this procedure, the rescuer manually breathes air into the victim's lungs, which simulates the act of inhalation. The air helps oxygenate the blood flowing through the lungs. The air mostly consists of carbon dioxide. But, it also contains all the oxygen that the rescuer's body did not use, constituting almost 17% of the exhaled air. This is enough to sustain the victim's life until the emergency response team takes over.

Before giving rescue breath, open the victim's airway using a head tilt, chin lift or jaw thrust maneuver if there is suspected spine and neck injury. Avoid excessive ventilation, and chest rise should appear natural.

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• Trained Rescuers: Rescuers trained in CPR/AED can assess emergencies, call 911 to seek professional help, and perform conventional CPR with chest compressions and rescue breathing.‍
• Untrained rescuers: Perform Hands-only CPR since it’s easy for the 911 operator to provide instructions and guidance over the phone.

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Chapter 2: How to Assess the Situation Before administrating CPR?

Assessing an emergency situation will help you make proper decisions and help to identify the most appropriate response to the emergency. Be aware of your surroundings and options for making it safe for yourself and anyone else on the scene.

You should initially ensure that the scene is safe when you first see an unresponsive victim with no normal breathing and no pulse who needs CPR.

How to assess an emergency situation?

1. Watch out for danger - Your first aim is to avoid putting anyone at risk. It won't be helpful if you become a second victim.
2. Assess the victim - Check the patient's response and condition. Do not move or shake the victim if you suspect a victim has suffered a spinal or neck injury.
3. Call 911 - One of the most important things to do in any emergency situation is to ensure that the emergency response team is contacted fast and gives relevant information as clearly and accurately as possible.
4. Resuscitate and treat injuries as necessary

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Chapter 3: What is the Chain of Survival?

Keep the Emergency Cardiovascular Care's Chain of Survival when preparing to perform CPR. These are the five crucial steps in the chain of survival:

• Immediate recognition of cardiac emergencies, call 911.
• CPR with emphasis on chest compressions. Decreasing the delay in beginning compressions increases survival rates.
• Provide rapid defibrillation with an AED within minutes of the onset of symptoms.
• Trained medics administer advanced life support.
• Post-cardiac arrest care is administered in a hospital setting.

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Chapter 4: What is Good Samaritan Law?

Under Good Samaritan Laws, a person assisting an injured person is free from civil liability under the following conditions:

• The person helping must be acting voluntarily
• Without the expectation of reimbursement or compensation in any form
• Aid must be given at the scene of the emergency.

Good Samaritan Laws do not apply to persons providing advice and aid through their regular employment, such as paramedics, doctors, nurses, and other healthcare professionals.

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Chapter 5: What is the C-A-B Method?

With the Compressions – Airway – Breathing (C-A-B) method, a victim receives compressions faster and provides for quicker critical blood flow to vital organs.

With the Compressions – Airway – Breathing (C-A-B) method, a victim receives compressions faster and provides for quicker critical blood flow to vital organs.

• "C" for Compressions - You should give at least 100 to 120 compressions per minute in cycles of 30 compressions and two breaths (30:2). Chest recoil is vital after each compression.
• "A" for Airway - Tilt the victim's head slightly backward and open the airway.
• "B" for B - For adults, pinch the nose and breath into the mouth at 10 to 12 breaths per minute. For infants and smaller children, cover the mouth and nose with your mouth and breath in at 12 to 20 breaths per minute. Each breath should last for at least one second.
  

Chapter 6: When is CPR Needed?

CPR should be performed on an adult, child, or infant victim if they are unresponsive and not breathing normally or not breathing at all. Situations where CPR is needed:

1. When someone suddenly collapses
2. When someone is unconscious
3. Breathing problems
4. Electrocution injuries
5. Drowning
6. Drug overdose
7. Exposure to smoke or inhalants

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Chapter 7: Adult CPR

Check for consciousness: To check for consciousness, tap on the adult victim's shoulder firmly and ask, "Are you OK?" loudly.

When to Activate EMS: If the victim is unconscious, call 911 or ask someone else to call before performing CPR. Even if you perform high-quality CPR on the spot, getting paramedics to the scene as quickly as possible is crucial. If possible, ask a bystander to look for an AED.

Breathing and airway: While waiting for the emergency medical team, check the breathing for about 10 seconds. If the breathing is normal, put the victim in the recovery position and wait for the responders to arrive. If you do not hear breathing or only hear a few gasps, begin CPR immediately.

How to provide quality chest compressions for adults?

• Place the victim on their back on a firm, flat surface.
• Perform chest compressions on the lower half of the breastbone (sternum).
• Alternate between 30 chest compressions and two rescue breaths, with 2 inches of compression depth.
• Push hard and fast at a rate of 100-120 compressions per minute.
• Allow the chest to recoil after each compression.
• Avoid excessive ventilation.

Chest Compression Fraction: The total percentage of resuscitation time during cardiac arrest. Try to minimize the interruptions in chest compressions. You must target at least 60 percent chest compression fraction goal.

If an AED is available, a bystander in a public place or a family member can use it to deliver a shock to the heart to restore regular rhythm.

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Recommendations:

• 2-2.4 inches compression depth
• 100-120 compressions per minute
• 30:2 compression to ventilation ratio
• One breath every 6 seconds

Chapter 8: Child CPR

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

Check for consciousness: Tap the child's shoulder and ask, "Are you OK?" loudly. It's also important to check the scene for factors that could harm you, such as traffic or fire.

When to Activate EMS: If the child is not responding, call 911 immediately 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, contact 911 first before performing CPR.

Breathing and airway: Place your ear next to the child's mouth and listen for 10 seconds. If you do not hear breathing or only hear occasional gasps, begin CPR immediately.

If the child is unconscious but still breathing, do not perform CPR. Instead, keep monitoring their breathing and perform CPR if they stop breathing.

Give 30 chest compression and 2 rescue breaths

• Place two hands (or one hand if the child is tiny) on the child's sternum.
• Push hard and fast to a compression 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 have had CPR training and feel comfortable performing the steps, push on the chest 30 times, then give two rescue breaths.
• Repeat the cycles of 30 chest compressions and two rescue breaths until help arrives or the child wakes up.

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Recommendations::

• 2 inches compression depth
• 100-120 compressions per minute
• 30:2 compression to ventilation ratio
• One breath every 6 seconds

Chapter 9: Infant CPR

Step 1: Check for Consciousness
Flick the bottom of the infant's foot to elicit a response. This takes the place of tapping the shoulder of an older person.

Step 2: Activating EMS
If there is no response from the infant, call 911 immediately or ask a bystander to call. If you are alone, contact 911 first before performing CPR.

Step 3: Chest Compressions
Place two fingers of your one hand in the center of the chest. Gently use your fingers to compress the chest about 1.5 inches deep. Perform two compressions per second, just as you would when giving an adult CPR.

Step 4: Rescue Breathing
If you are comfortable giving rescue breaths, give two of them between each series of 30 chest compressions, just as you would with an older person.

Repeat cycles of 30 chest compressions and two rescue breaths until help arrives or the infant wakes up.

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Recommendations:

• Compression depth: 1/3 of the chest circumference or about 1.5 inches
• Compression rate: 100-120 beats per minute
• One Rescuer - 30:2
• Two or more Rescuers - 15:2
• One breath every 3-5 seconds

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Chapter 10: 2-Rescuer CPR

If you encounter an unconscious victim and another person is available to help, ask that person to call 911 and find an AED while assessing whether the victim needs CPR. If the victim requires CPR, start CPR, beginning with compressions. Here's how to perform CPR when there are two rescuers present:

Step 1: Check for Consciousness
Tap the victim's shoulder and ask if they are okay. If the victim is not breathing or only gasping, stay with the victim.

Step 2: Call 911
Rescuer 2 will call 911 and leaves to retrieve an AED.

Step 3: Check for breathing and pulse.
Rescuer 1 checks for a pulse. If there's no pulse, the rescuer will begin CPR, starting with chest compressions.

Step 4: Begin CPR
Rescuer 1 will continue giving chest compressions and rescue breaths until Rescuer 2 returns with an AED.

Step 5: Use an AED

• When rescuer 2 arrives with an AED, place it on the side opposite Rescuer 1, who is performing chest compressions.
• Rescuer 2 will turn on the AED and attaches the pads to the victim's chest. Rescuer 1 will continue CPR while the pads are being placed until it is time to analyze the heart rhythm.
• Rescuer 2 clears the victim, ensuring neither rescuer touches the victim and waits for the AED to analyze.
• Rescuer 2 will push the SHOCK button if a shock is indicated.
• If no shock is needed, rescuer 2 will resume chest compressions.
• During analysis, Rescuer 2 and Rescuer 1 should switch positions to prevent rescuer fatigue and ensure that rescuers provide high-quality chest compressions at the proper rate and depth.

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When the second rescuer returns without an AED:

• Continue performing chest compressions and count the compressions aloud.
• Rescuer 2 should keep the person's airway open using the head tilt chin lift maneuver.
• The second rescuer will give two rescue breaths after every 30 compressions.
• Rescuers 1 and 2 should switch positions every two minutes, so neither gets tired.

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Chapter 11: What is an Automated External Defibrillator?

An AED or Automated External Defibrillator is a mechanical device that increases the victim's chances of survival. It is designed to assess the electrical output of a victim's heart and provide an electrical shock if needed. It is utilized when a victim experiences sudden cardiac arrest.

Pulseless Ventricular Tachycardia: A type of arrhythmias when the ventricles begin to contract at an extremely fast pace. This results in inefficient pumping of blood. You won't be able to feel a pulse due to the fast pace.

Ventricular fibrillation: During Ventricular fibrillation is disordered electrical activity in the ventricles. As a result, the heartbeat is completely unsynchronized, and the heart begins to quiver instead of pumping blood.

When ventricular fibrillation and pulseless ventricular tachycardia are present, the AED can "shock" the heart into regaining its normal rhythm.

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How to use an AED?

• Assess the victim for SCA.
• Immediately call 911. If more than one rescuer is present, provide CPR while the AED is retrieved and prepared.
• Once powered on, the machine will instruct the rescuer to place the electrodes (pads) over the victim's heart. If the victim has a hairy chest, shave the area that will be covered by electrode pads.
• Choose adult pads for victims who are eight years of age or older. You may use adult pads for children below eight years old, but you should ensure the pads do not touch or overlap.
• A manual defibrillator is preferred in infants.
• The AED will scan the victim's heart, checking if the shock is necessary. Ensure that no one is in contact with the victim while the AED assesses the victim.
• Rescuers should follow the prompts given by the machine. AED will charge and automatically shock the victim if necessary. Ensure that no one else is touching the victim to reduce the risk of bystanders being shocked.
• Following the initial shock, the machine will reassess the victim to determine if an additional shock is necessary.
• Continue CPR when prompted.

Chapter 12: How to Treat Choking? (Adult and Child)

A person chokes when a foreign object becomes trapped at the back of the throat, either blocking the airway or causing a muscle spasm. If a choking person is conscious, do the Heimlich maneuver. If he is unconscious, perform CPR.

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Heimlich Maneuver

• Stand behind the victim, bringing your arms around the abdomen.
• Make a fist with one hand, placing your thumb against the victim's abdomen. The opposite hand reaches around the victim and grasps the fist to provide support.
• Place your hand below the victim's ribcage and perform an abdominal thrust using quick upward thrust with a steady force until the object is expelled.
• Discontinue the Heimlich Maneuver when the victim begins to cough, speak, or lose consciousness.

Steps for treating Unconscious Choking Victims

• Call 911.
• Lay the victim face-up on the floor.
• Open the victim's airway and attempt to ventilate the victim as explained in the CPR guidelines. If the airway is still blocked, reposition the head and try to clear it again. If this is still ineffective, begin compressions.
• Kneel next to the victim and deliver a series of 15 compressions, as used for CPR. Alternate series of 15 compressions with attempts to clear the victim's airway and ventilate, as described in the earlier steps.
• Discontinue compressions when the object is ejected, rescue breathing is successful, or the victim begins to breathe independently.
• Place the revived victim in the recovery position.

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Chapter 13: How to Treat Infant Choking?

Do not use the Heimlich Maneuver with infants. Instead, you must put the baby face down on your forearm, supporting the head and chest. Then, using the other hand, give five sharp blows to the back. Next, use your index finger as a hook to clear objects from the baby's mouth, but do not reach blindly down the throat.

If the baby has not stopped choking, use two fingers to administer five chest compressions, as used for CPR. Check the baby's mouth for additional foreign objects. Repeat this sequence three times. If choking continues, call 911. Continue the back blows, mouth sweeps, and compressions until help arrives.

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Chapter 14: Rescue Breathing

Rescue breathing or mouth-to-mouth ventilation is used when someone has stopped breathing. Do not give breaths too rapidly or forcefully to avoid air getting into the victim's stomach. It may cause vomiting, distention, and less room for lung expansion.

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How to provide mouth-to-mouth ventilations?

• Gently tilt the victim's head back. Use one hand to hold their chin and lift it. Keep the victim's mouth open using your thumb.
• Place your hand on their forehead and pinch the nose closed with your other hand.
• Create a proper seal when using your lips to surround the victim's mouth
• Blow into the victim's mouth for one full second and watch for the chest to rise.
• If the chest does not rise, tilt the victim's head further back and give a second breath.
• If you cannot see the chest rise in two breaths, continue giving chest compressions.

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Chapter 15: Recovery Position

If the victim, whether it's an adult, child or infant is breathing and has a pulse, put him in the recovery position while waiting for EMS to arrive. This position keeps the victim's airway open, prevents the aspiration of fluids into the lungs, and allows fluid to drain from the mouth. Here's how to put the victim into a recovery position:

1. Extend the victim's arm closest to you above the victim's head.
2. Place the victim's leg farthest away from you over his other leg.
3. Place the victim's arm farthest from you across his chest.
4. Supporting the head and neck, roll the victim towards you.
5. Position the victim's top leg, so the knee props up the victim's body
6. Place the victim's hand or arm under the chin to keep the airway open.

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Frequently Asked Questions

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How long should it take to determine if a victim is not responsive, not breathing, and has no pulse before you begin compressions?

When assessing signs of cardiac arrest in an unresponsive patient, it is crucial to thoroughly check for breathing and pulse for a duration of 10 seconds. This time span allows rescuers to accurately assess the victim's condition before deciding to initiate chest compressions. Taking these moments ensures a comprehensive evaluation and helps in making informed decisions about the appropriate course of action.

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When two rescuers are available, what are the responsibilities of the rescuer giving rescue breaths?

In a scenario with two rescuers, the individual providing rescue breaths shoulders several critical responsibilities. Apart from maintaining an open airway, they are tasked with delivering effective rescue breaths while closely monitoring for chest rise. Simultaneously, this rescuer must exercise caution to avoid excessive ventilation or over-inflation. This division of responsibilities ensures a coordinated and efficient response, maximizing the chances of successful resuscitation.

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How do you treat a conscious victim who is choking

For conscious victims experiencing choking, the approach varies based on age. In adults and children, the Heimlich Maneuver is employed to dislodge the obstructing object. However, for infants, the recommended method involves alternating between 5 chest thrusts and 5 back blows. It is crucial to act promptly and appropriately to relieve the obstruction and prevent further complications. In the unfortunate event that the victim loses consciousness, CPR becomes the immediate course of action.

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Why is it important to push hard and fast?

The significance of pushing hard and fast during chest compressions lies in the need to generate sufficient blood flow. Rapid and forceful compressions help maintain circulation, delivering oxygen-rich blood to vital organs and tissues. This vigorous approach is vital for increasing the likelihood of a successful outcome in cardiac arrest situations. The emphasis on speed and depth is based on CPR guidelines 2023 that highlight the importance of these factors in effective cardiopulmonary resuscitation (CPR).

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How do you know that your breaths are getting into the victim?

Ensuring that rescue breaths are effectively reaching the victim is imperative for successful resuscitation. This is monitored by observing the chest for visible signs of rising during each breath. If the chest fails to rise, it signals a potential issue with airway patency or the delivery of rescue breaths. In such cases, it is necessary to reassess the airway, make adjustments, and continue administering breaths until signs of effective ventilation, such as chest rise, are observed.

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What device should you use to provide ventilation to a victim?

In one-rescuer CPR situations, a pocket mask is the recommended device for supplying breaths. These masks provide a barrier between the rescuer and the victim, preventing direct contact and reducing the risk of infection transmission. In more advanced or professional settings, bag-valve-mask (BVM) devices are preferred equipment for delivering positive pressure ventilation to the victim. These devices offer better control and efficiency in providing the necessary breaths during resuscitation efforts.

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If you are interested in getting certified in CPR, we offer CPR and First Aid training online. CPR classes are typically completed in 1 hour, depending on which format you choose. We follow the latest guidelines of the American Heart Association and Emergency Cardiovascular Care. After successful completion of the CPR certification class and passing the certification exam, you will be able to get a certificate that will allow you to respond to a wide variety of medical emergencies.