Warning: This article is not a substitute for CPR training.
The American Heart Association changed its guidelines for CPR in 2006. These instructions are based on the new guidelines.
Before approaching any emergency scene, you must always ensure that the scene is safe for you, the rescuer, to enter. Inform a bystander to call 9-1-1, explain the situation, and immediately return to the scene.
Note: This can be especially important if a child is sent to call 9-1-1 as he or she may be scared and ordering him to return will increase the likelihood that the child will make the call.
Remember your ABC's. In any emergency situation your first concern will always be the pneumonic ABC (airway, breathing and circulation), in that order.
Open the patient's airway by the head-tilt, chin-lift maneuver. First open the mouth and remove any major obstructions.
Use this maneuver for all patients, even for injured victims.
- Place two fingers of one hand below the patient's chin and place the other hand on the patient's forehead.
- Lift upward with your fingers and press back on the forehead with your hand so that the head is tilted back and the chin is raised.
Determine whether the patient is breathing. Opening the airway may have restored your patient's breathing. If the patient is breathing, you know he has a pulse. You must maintain the open airway and check breathing regularly.
If the patient is not breathing, you must breathe for him. Take 5-10 seconds to establish that the victim is not breathing, then:
- Pinch his nostrils closed.
- Seal your mouth over and around his.
- Take a normal (not a deep) breath.
- Breathe slowly into the patient's mouth, over 1 second.
- As you breathe, look for the patient's chest to rise and fall. This will tell you whether you are breathing for him effectively.
- If the patient's chest has good rise and fall, provide 2 breaths, each over a 1 second period and move on to circulation.
- If you are not breathing effectively for the patient, reposition the airway with the chin-lift, head-tilt maneuver and try again.
- If, after two attempts, you are still unable to ventilate the patient, assume that there is an airway obstruction and attempt the Heimlich Maneuver.
Note: If you are unable to breathe through the patient's mouth for any reason, you can use your hand to seal the patient's mouth, place your mouth over his nose, and breathe through his nose.
- If you have initiated rescue breathing, do not check for a pulse. Begin compressions immediately after 2 rescue breaths have been administered.
- Place the heel of one hand 2-3 inches above the xyphoid process (tip of the sternum) or at the nipple line (roughly).
- Place your other hand on top the first and interlace your fingers.
- Lock your elbows and move your body directly above the patient. This allows you to use the weight of your body, instead of your muscles, to perform compressions. You'll tire less easily.
- Compress the chest wall about 1.5-2 inches down (1/3 to 1/2 the total chest depth).
Note: One of the biggest problems with CPR is ineffective compressions. Keep this in mind and don't be afraid to actually compress the chest wall-you're trying to pump the heart by squeezing the rib cage.
- Push hard and fast.
- Perform 30 compressions to every 2 breaths. This is ratio should be used for all CPR patients over 1 year old during single-rescuer CPR.
- After 5 cycles of this (2 minutes), stop CPR and check for a pulse.
- If no pulse, continue CPR until help arrives, periodically (every few minutes) checking for a pulse.
- If a pulse is felt, reassess airway and circulation. Continue to check the pulse once a minute to ensure that you don't lose it.