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Cardiopulmonary Resuscitation, commonly known as CPR, is a life-saving measure that is performed to restore breathing and circulation in a patient who has no pulse and is no longer breathing. The three main steps to always remember are: 1. Circulation 2. Airway 3. Breathing These three steps make up the acronym CAB, which summarizes the main goals of CPR. The main goals of CPR are to restore circulation to the heart, ensure that the an open airway exists, and provide artificial ventilations. If done correctly, this will ensure that the patient has the highest chance of survival. CPR is particularly important in the pre-hospital setting, where this life-saving technique can keep a person alive while waiting for more advanced health care. The following steps walk through the basic CPR skills that may help YOU to save a life. 1. 2. 3. 4. 5. 6. Determining Responsiveness Checking Airway Checking Pulse Performing Chest Compressions Performing Rescue Breathing Repetition

*Note: This instruction set is meant as a refresher for individuals previously certified in CPR. It is not a substitute for a professional CPR certification course.

Questions to be Answered Before Getting Started:

When should CPR be initiated? CPR is only effective when it is initiated as soon as possible. Where should CPR be performed? CPR can be performed wherever and whenever necessary, but it is important that the patient lies on a hard surface. CPR involves chest compression, and a soft surface (such as a bed) under the patient will weaken the effectiveness of your compressions. How long should CPR be performed? There is no definite time limit on the effectiveness of CPR. In an emergency situation, you should continue to perform CPR on the patient until you are no longer able or until advanced life support takes over.

*Caution: This instruction set should not be used as a real-time guide. It should be read and understood in its entirety before being applied in an emergency situation.

Determining responsiveness
1. Upon arriving at the scene, ask someone nearby to call 911 immediately (Figure 1). If no one else is at the scene, you should call 911 and request an ambulance.

Figure 1

2. Approach the patient and ask him/her for his/her name. Then, gently nudge the patient to see if he/she responds (Figure 2). 3. If there is no response, position the patient on his/her back. *Note: In Figures 1 & 2, the patient is already on his back.
Figure 2

Checking Airway
4. Check the mouth for foreign objects (Figure 3). * Caution: Do not insert fingers into the patients if there is a foreign object. Doing so may push the object farther back into the throat, which could compromise breathing.

Figure 3

5. If no foreign objects are present, gently place one hand on the patients forehead and two fingers under the chin. Then, push the head back while lifting the chin upward to create an open airway (Figure 4).

Figure 4

6. Next, determine if the patient is breathing by watching for chest rise and fall. Place your ear just over the mouth of the patient to listen and feel for exhalation, while looking down the patient's body to observe for chest movement (Figure 5). *Caution: Do not contact the patient's mouth, as this may restrict airflow.
Figure 5

Checking Pulse
7. Once it has been determined that the patient is unresponsive and not breathing, check for a pulse from the carotid artery. Do this by locating the windpipe at the front of the neck and slide two fingers to one side under the jaw line. Check pulse for five seconds (Figure 6). *Caution: Do not use firm pressure, as this can decrease air supply or damage the trachea. *Note: the windpipe, or trachea, can be located by finding what feels like a solid tube running down the front of the neck just under the skin.

Figure 6

Performing Chest Compressions

8. Kneel beside the patient's chest (Figure 7). 9. Place heel of one hand in between the patients nipples (Figure 7). Place heel of the other hand over the first and interlock fingers (Figure 8).

Figure 7

10. Lock elbows and position your shoulders directly over your hands. Depress the chest 1 - 2 inches in a fluid downward movement (Figure 8). * Note: Because of the great amount of force when performing CPR, one or more of the patients ribs may break. This should not deter you from continuing this life-saving procedure.

Figure 8

11. Allow the chest to return to its normal position and continue in a rhythmic fashion at about 100 compressions per minute (Figure 9). *Note: The correct rate of compressions can be achieved by performing them to the beat of Another One Bites the Dust, by Queen. 12. Perform 30 chest compressions.
Figure 9

Performing Rescue Breathing

13. Immediately following chest compressions, place one hand on the patient's chin, and the other hand on the patient's forehead (Figure 10), while pinching the patient's nose closed. Note: Pinching the patient's nose closed ensures that rescue breaths do not bypass the lungs and simply exit through the nose. This is an important aspect of rescue breathing but is not depicted in Figure 10. 14. Tilt the head back to create an open airway.
Figure 10

15. Place your mouth over patients mouth and form an airtight seal. Make sure to pinch the patients nose closed to ensure proper ventilations. Give 2 rescue breaths and make sure the patients chest rises with each breath. *Caution: Do not perform rescue breathing if you are not trained to do so, instead continue with chest compressions.

16. Continue the pattern of 30 compressions followed by 2 rescue breaths until paramedics arrive and take over. *Note: It is best to switch between chest compressions and rescue breaths every 5 cycles. This way, the provider will not become fatigued so quickly. 17. Periodically check pulse in between cycles.

CPR is an invaluable tool that can mean the difference between life and death for a patient, especially in the pre-hospital setting. For this reason it is of the utmost importance that citizens become familiar with the CPR procedure in order to perform it effectively from memory. To reiterate, the three main points to remember are the patients circulation, airway and breathing (CAB). Through effective CPR, it is possible to provide circulation to the heart and artificial ventilation for a patient temporarily. However, it is important to note that CPR is not in any way a substitute for professional medical care and so the first step in any medical emergency should always be to dial 911.