CPR and AED

Cardiopulmonary resuscitation and defibrillator use: the most critical life-saving skills.

When the Heart Stops

Cardiac arrest = death begins. Every minute without CPR, survival drops 7 to 10 percent.

Brain damage begins: 4 to 6 minutes without oxygen. Irreversible death: 8 to 10 minutes without intervention.

Your actions matter. Bystander CPR doubles or triples survival rates. The compressions you do, even imperfect ones, are better than the perfect ones nobody is doing.

Recognizing Cardiac Arrest

Signs:

• Sudden collapse
• No response to shaking/shouting
• No breathing OR only gasping (agonal breathing)
• No pulse (don't waste time checking; if not breathing normally, start CPR)

Gasping is NOT breathing. It looks like fish-out-of-water gasps. Start CPR.

Adult CPR (Hands-Only)

For untrained rescuers or those uncomfortable with rescue breaths:

Steps

1. Ensure scene is safe

2. Check responsiveness

   • Tap shoulder firmly
   • Shout "Are you okay?"

3. Call 911 (or have someone call)

   • Put on speaker phone if alone
   • Send someone for AED

4. Position victim

   • Flat on back on firm surface

5. Begin compressions

   • Place heel of one hand on center of chest (between nipples)
   • Place other hand on top, fingers interlaced
   • Keep arms straight, shoulders over hands
   • Push hard and fast

Compression Guidelines

Tempo: Think of "Stayin' Alive" by the Bee Gees (100 bpm)

Continue Until

• Professional help takes over
• AED is ready to analyze
• Victim starts breathing normally
• You are physically unable to continue

Adult CPR (With Rescue Breaths)

For trained rescuers:

Cycle: 30 compressions : 2 breaths

1. 30 compressions (as above)

2. Open airway

   • Head tilt: Hand on forehead, tilt head back
   • Chin lift: Fingers under chin, lift up

3. Give 2 rescue breaths

   • Pinch nose closed
   • Create seal over mouth
   • Blow for 1 second
   • Watch for chest rise
   • Give second breath

4. Resume compressions immediately

If breath doesn't go in:

• Retilt head
• Try again
• If still doesn't work, continue compressions (may be choking)

Two-Rescuer CPR

More effective when two people are available:

Switch to prevent fatigue. Compression quality degrades quickly.

Child CPR (Age 1 to Puberty)

Same ratio: 30:2

Differences from adult:

• May use one or two hands for compressions
• Depth: At least 1/3 chest depth (~2 inches)
• Less force needed
• Call 911 after 2 minutes of CPR if alone (children often arrest from respiratory issues)

Infant CPR (Under Age 1)

Compressions

• Two fingers on breastbone, just below nipple line
• Depth: At least 1/3 chest depth (~1.5 inches)
• Rate: 100-120 per minute
• Allow full recoil

Breaths

• Cover mouth AND nose with your mouth
• Small puffs (just enough to see chest rise)
• Don't over-inflate

Cycle

30:2 for single rescuer 15:2 for two rescuers

Using an AED

What Is an AED?

Automated External Defibrillator: a device that can analyze heart rhythm and deliver an electrical shock to restart a normal rhythm.

AEDs are designed for untrained users. They give voice prompts and won't shock unless appropriate.

When to Use

• Victim is unresponsive
• Not breathing normally
• No pulse
• AED is available

Start CPR first. Apply AED as soon as available without delaying compressions.

Steps

1. Turn on AED

   • Press power button
   • Follow voice prompts

2. Expose chest

   • Remove clothing
   • Dry chest if wet
   • Remove medication patches (with gloved hand)
   • Move jewelry/underwire if necessary

3. Apply pads

   • One pad: Upper right chest (below collarbone)
   • One pad: Lower left side (below armpit)
   • Follow pictures on pads
   • Press firmly

4. Analyze rhythm

   • AED will say "Analyzing, don't touch patient"
   • Everyone clear, don't touch victim

5. If shock advised

   • AED will say "Shock advised"
   • Say "Clear!" loudly
   • Ensure no one is touching victim
   • Press shock button

6. Resume CPR immediately

   • Don't wait for another analysis
   • Continue for 2 minutes
   • AED will prompt when to stop for analysis

Special Situations

Where to Find AEDs

• Airports
• Shopping malls
• Gyms
• Schools
• Office buildings
• Sports venues
• Public buildings

Look for AED signs (heart with lightning bolt).

Recovery Position

If victim starts breathing normally but remains unconscious:

1. Kneel beside victim
2. Place arm nearest you at right angle
3. Bring far arm across chest, hold hand against near cheek
4. Bend far knee, pull it up
5. Roll victim toward you onto side
6. Tilt head back to keep airway open
7. Adjust top leg to stabilize
8. Monitor breathing continuously

Do NOT use if spinal injury suspected.

Common Mistakes

CPR Quality Matters

High-quality CPR:

• Push hard (at least 2 inches)
• Push fast (100-120/min)
• Allow complete recoil
• Minimize interruptions
• Avoid excessive ventilation
• Switch rescuers every 2 minutes

When to Stop CPR

• Professional help takes over
• AED prompts to stop for analysis/shock
• Victim shows obvious signs of life (breathing, moving)
• Scene becomes unsafe
• You are physically exhausted and no one can take over
• Physician or authorized person pronounces death

Don't give up too easily. People have survived after 30+ minutes of CPR.

Training and Practice

Get Certified

• American Heart Association BLS
• American Red Cross CPR
• Local hospital or fire department courses

Practice Regularly

• Skills decay without practice
• Certification typically valid 2 years
• Review annually at minimum
• Practice on mannequin

Keep Current

CPR guidelines are updated periodically. Stay current with latest recommendations.

Key Points

1. Act immediately - Every second counts
2. Push hard and fast - 2+ inches, 100-120/min
3. Minimize interruptions - Keep blood flowing
4. Use AED as soon as available - It saves lives
5. Don't give up - Continue until help arrives
6. Get trained - Hands-on practice is essential

Next Steps

Continue to 03-bleeding-wounds.md to learn how to stop external bleeding before circulation collapses.