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Adult CPR

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(calm music) (beeping) (people talking) (balls bouncing) - Now in this segment we're gonna cover adult CPR. Now this is about an 18 year old male. Witnesses say that he was playing basketball when suddenly he started to lose his balance, he clutched his chest, and collapsed to the floor and was not responsive. We find him on the floor the same way they described it. Now before we get into actually doing the CPR skills, we still wanna make sure that the scene is safe, he did not step on an electric cord, there were no gasses in the area that made him collapse. Once we can be sure that the scene is safe, we make sure our gloves are on, our CPR shield with a one-way valve is available, and now we can begin with our taps and shouts. So we tap and shout on the collarbone. Sir, are you alright, are you okay? He does not respond to our taps and shouts and he's not apparently breathing normally at all. So we're gonna go ahead and activate EMS, you in the plaid shirt, go call 911 and come back. And if you see an AED please bring it back with you. If there's nobody to go call 911 for you, and you have a cell phone, dial 911, hit the speaker phone button and leave it on so that the dispatcher can coach you through the CPR along the way. But now because we know he's unresponsive, not breathing normally, I'm gonna go straight into my CPR compressions. A few pieces to note here when we talk about the chest compressions. The landmark we're looking for to do chest compressions is the first palm between the center of the chest, between the nipple line, on the lower third of the sternum. We wanna be sure to interlock our top hand over the first hand, keeping our elbows locked, and leaning over the patient, we wanna use our upper body weight to help us do that consistent chest compression for a longer period of time than if we're trying to use our upper body strength. The second piece of that, when we do our full two to 2.4 inch deep compression, we wanna make sure that we come back all the way back up and allow the chest to fully recoil before we give our second, third, and consecutive chest compression. The rate by which we're going to do these chest compressions is between 100 and 120 times per minute. That means we're gonna be delivering at least two chest compressions every second. And this is what it looks like. One and two and three and four and five and six and seven and eight nine, 10, 11 and 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Now I'm gonna do a head tilt chin lift. I'm gonna cover his nose and mouth with my mask, pinching his nose, opening his mouth, now I deliver two rescue breaths. Now I know the two breaths went in because I saw a good chest rise and fall. Now I'm going straight back into my 30 two inch to 2.4 inch deep compressions at a rate of 100 to 120 times. Two and three and four and five and six and seven and eight, and 10 and 11 and 12 and 13 and 14 and 15 and so on up to 30, followed by two more rescue breaths. And we're gonna continue this 30 compressions to two rescue breaths until EMS arrives, until an AED arrives on scene, or until the patient starts to respond and breathe normally.

In this lesson, we'll cover how to administer CPR on an adult victim.

In situations where CPR is needed, you personally may have witnessed the victim exhibit symptoms and go unresponsive. Others may have witnessed the incident. Or no one was around to see what really happened. If someone was there to witness the incident, what they likely would have noticed is a victim who:

  • Loses their balance
  • Clutches their chest
  • Collapses to the ground or floor

If you arrive on the scene after this happens, in cardiac arrest emergencies, the victim will usually also be unresponsive and not breathing normally, if at all. Let's assume for this lesson that that's how you found the victim. And that CPR is required.

CPR is a combination of chest compressions and ventilations that circulates blood and oxygen to the brain and other vital organs for a person whose heart and breathing have stopped. Oxygen is vital for life and it's only a matter of minutes before the brain begins to be negatively impacted.

How to Provide Care

Warning: Don't let the repetition of this next paragraph lull you into overlooking or dismissing the importance of scene safety. What if you show up to the scene and there's a live electrical wire, or poisonous gases in the air, and this is why the victim collapsed? Don't make assumptions, and don't become another victim.

Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue shield available and begin calling out to the victim to assess whether or not he or she is responsive.

Are you OK? Can you hear me?

If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.

  • Call 911 and activate EMS. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.

Pro Tip #1: As long as you have your cell phone, you're never alone. If no one is around to help you and you aren't sure what to do, call 911 on your cell phone, put it on speaker, and follow their instructions. Dispatch can help coach you through the situation.

  • If you've determined at this point that the victim is unresponsive and not breathing normally continue immediately with CPR, beginning with chest compressions.

Pro Tip #2: Chest compression landmarks: Aim for the center of the chest, between the nipples and on the lower one-third of the sternum. Hand placement: Place your first palm on that landmark and interlock the fingers on your top hand over your first.

  • Lean over the victim, position your hands as indicated above, and in the video, and lock your elbows.
  • Use your upper body weight to supply the force needed for chest compressions and compress at a depth between 2 – 2.4 inches.
  • Perform 30 chest compressions at a rate between 100 – 120 compressions per minute, which amounts to around two compression every second. Make sure you allow the victim's chest to come all the way back up before performing your next compression.

Pro Tip #3: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.

  • Lift the victim's chin and tilt his or her head back.
  • Grab the rescue shield and place it over the victim's mouth and nose.
  • Pinch the victim's nose and open their mouth.
  • Deliver two rescue breaths – Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.

Pro Tip #4: Don't forget to watch the victim's chest when performing chest compressions. If the chest doesn't rise, then you might be dealing with another problem and one that likely includes an obstructed airway.

  • Go right back into 30 chest compressions followed again by two rescue breaths.

Continue to perform 30 chest compressions to two rescue breaths until EMS arrives, an AED is located, someone equally trained can relieve you, or the victim becomes responsive and begins breathing normally again.

A Few Common Questions About Adult CPR

Why is it important to use your upper body weight when performing chest compressions?

If you need to perform CPR for a longer period of time, using only your upper body strength will begin to fatigue you. As you become fatigued, your compression rate and depth may falter, as would the quality of CPR and the victim's chances of recovering.

Can I stop doing CPR once I've started?

Once you begin CPR, it's important not to stop. If you must stop, do so for no longer than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue.

Is there anything else I can do to help a cardiac arrest victim?

The best thing you can do in these situations is to provide high-quality CPR, as performing CPR correctly will give the victim the best chance of survival. So, what constitutes high-quality CPR?

High-Quality CPR

  • Performing chest compressions at a rate of 100-120 per minute
  • Compressing to a depth of at least 2 inches but not exceeding 2.4
  • Allowing for full recoil after each compression
  • Minimizing pauses in compressions
  • Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise

Pro Tip #5: Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.

Low-Quality CPR

  • Compressing at a rate slower than 100 per minute or faster than 120 per minute
  • Compressing to a depth of less than two inches or greater than 2.4 inches
  • Leaning on the chest between compressions or performing compressions while not directly over the victim's heart
  • Interrupting compressions for greater than 10 seconds
  • Providing excessive ventilation – too many breaths or breaths with excessive force