CPR - Cardiopulmonary Resuscitation
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Medical Encyclopedia
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CPR - adult
Alternative names
Cardiopulmonary resuscitation - adult; Rescue
breathing and chest compressions - adult; Resuscitation - cardiopulmonary -
adult
CPR is a lifesaving procedure that is
performed when someone's breathing or heartbeat has stopped, as in cases of electric
shock, drowning, or heart attack. CPR is a combination of:
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Rescue breathing, which provides oxygen to a person's lungs
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Chest compressions, which keep the person's blood circulating.
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Permanent brain damage or death can occur
within minutes if a person's blood flow stops. Therefore, you must continue
these procedures until the person's heartbeat and breathing return, or trained
medical help arrives.
CPR can be lifesaving, but it is best
performed by those who have been trained in an accredited CPR course. The
procedures described here are not a substitute for CPR training. (See www.americanheart.org
for classes near you.)
Time is very important when dealing with an unconscious
person who is not breathing. Permanent brain damage begins after only 4 minutes
without oxygen, and death can occur in as little as 4 to 6 minutes later.
When a bystander -- whether friend, family,
or stranger -- starts CPR before emergency support arrives, the chance of
surviving is tripled! Nevertheless, when most emergency workers arrive at a
cardiac arrest, they usually find no one giving CPR. This would be a
good time to find a convenient CPR class and learn how to save lives.
Machines called automated external
defibrillators or AEDs can be found in many public places, and are available for
home use. These machines have pads or paddles to place on the chest during a
life-threatening emergency. They use computers to automatically evaluate the
heart rhythm and administer a sudden shock if, and only if, that shock is needed
to get the heart back into the right rhythm. Most people in ventricular
fibrillation cardiac arrest will survive if shocked within 3 minutes.
In adults, major reasons that heartbeat and
breathing stop include heart disease, injuries and accidents, excessive
bleeding, drug overdose, and sepsis
(infection in the bloodstream).
The following steps are based on instructions
from the American Heart Association.
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Check for responsiveness. Shake or tap the person
gently. See if the person moves or makes a noise. Shout, "Are you
OK?"
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Call 911 if there is no response. Shout for help and
send someone to call 911. If you are alone, call 911 even if you have to
leave the person.
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Carefully place the person on his or her back. If there is a chance the
person has a spinal injury, two people are needed to move the person without
twisting the head and neck.
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Open the airway. Lift up the chin with 2 fingers. At
the same time, push down on the forehead with the other hand.
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Look, listen, and feel for breathing. Place your ear
close to the person's mouth and nose. Watch for chest movement. Feel for
breath on your cheek.
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If the person is not breathing:
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Cover the person's mouth tightly with your mouth
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Pinch the nose closed
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Keep the chin lifted and head tilted
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Give 2 slow, full breaths
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If the chest does NOT rise, try the chin lift-head tilt again, and give
2 more breaths. If the chest still doesn't rise, check to see if something
is blocking the airway and try to remove it.
Look for signs of circulation -- normal breathing,
coughing, or movement. If these signs are absent, begin chest compressions.
Perform chest compressions:
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Place the heel of one hand on the breastbone -- right between the
nipples.
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Place the heel of your other hand on top of the first hand.
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Position your body directly over your hands. Your shoulders should
be in line with your hands. DO NOT lean back or forward. As you gaze
down, you should be looking directly down on your hands.
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Give 15 chest compressions. Each time, press down about 2 inches
into the chest. These compressions should be FAST with no pausing. Count
the 15 compressions quickly: "a, b, c, d, e, f, g, h, i, j, k, l,
m, n, off."
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Give the person 2 slow, full breaths. The chest should
rise.
Continue cycles of 15 chest compressions followed by 2 slow, full
breaths.
After about 1 minute (four cycles of 15 compressions and 2 breaths),
re-check for signs of circulation.
Repeat steps 11 and 12 until the person recovers or help arrives.
If the person starts breathing again, place
him or her in the recovery position. Periodically re-check for breathing and
signs of circulation until help arrives.
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If a spinal
injury is suspected, DO NOT tilt the head back when attempting to open
the airway. Instead, place your fingers on the jaw on each side of the head.
Lift the jaw forward. This keeps the head and neck from moving.
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If the person has signs of circulation -- normal breathing, coughing, or
movement -- DO NOT begin chest compressions. Doing so may cause the heart to
stop beating.
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Unless you are a health professional, DO NOT check for a pulse. Only a
healthcare professional is properly trained to check for a pulse.
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Call immediately for emergency medical
assistance if Return
to top
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If you have help, tell one person call 911 while
another person begins CPR.
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If you are alone, as soon as you determine that the
person is unresponsive, call 911 immediately. Then begin CPR.
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Eliminate or reduce risk factors that contribute to heart disease, such
as cigarette smoking, high cholesterol, high blood pressure, obesity, and
stress.
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Get plenty of exercise.
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See your doctor regularly.
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Always use seatbelts and drive safely.
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Avoid using illegal drugs.
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Marx JA, Hockberger RS, Walls RM, eds. Rosen’s
Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO:
Mosby; 2002;64-82.
Updated by: Jacqueline A. Hart, M.D., Department of
Internal Medicine, Newton-Wellesley Hospital, Boston, MA.
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