Cardiopulmonary Resuscitation (CPR)

About this medical skill
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Self-assessment
  • Review the NREMT Cardiac Arrest Management/ AED Skill sheet and practice work flow
  • Verify that you are compressing 2" in the chest either visually by hearing the click from the CPR manikin
  • Use a metronome to check the 100-120 compressions per minute rate
  • Example GIF of Chest compression rate
  • Deliver breaths over 1.5-2 seconds with a 4-5 second pause in between
  • Observe chest rise and fall (link to video here), reposition airway if not observed
  • In training manikins with a stomach simulator, ensure you are not filling the stomach with air
Equipment and materials
AED trainer
Adult CPR Manikin
Bag Valve Mask
CPR Pocket Mask
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CPR with AED is included in this California-based EMT program as it is required for National NREMT registration and skills verification for California Registration. This page is for Adult CPR, there are separate pages for children and infants which will be added in Winter quarter 2021

Cardiopulmonary Resuscitation (CPR) is a series of immediate actions to take to restore the flow of oxygenated blood to a person’s brain and organs when they suffer Sudden Cardiac Arrest (SCA). If the flow of oxygenated blood to the brain is not restored within a few minutes the victim could die or suffer irreversible brain damage.

CPR

Use CPR on a person who is unresponsive, pulseless and not breathing until further definitive steps such as applying an AED or Advanced Life Support (ALS) measures are possible. The steps include:

  1. Check that the area is safe for you and your patient, and that you have PPE (PENMAN)
  2. Check for alertness/responsiveness with a tap/shake of the shoulder (AVPU)
  3. Call 911 or for ALS backup, or ask someone else to
  4. Lay the person on their back
  5. Open their airway with a head tilt to slightly lift the chin
  6. Check for carotid pulse and breathing by feeling and listening for no more than 10 seconds
  7. If they are not breathing, first perform 30 chest compressions. Place your hands one on top of the other in the middle of the chest and push hard and fast. Use your body weight to help you administer compressions that are at least 2 inches deep and delivered at a rate of at least 100 compressions per minute. Let the chest rise fully between compressions. See the Self-assessment sidebar for methods of determining if you are doing this correctly.
  8. Perform two rescue breaths with the person's head tilted back slightly and the chin lifted using a BVM, a pocket mask or direct mouth to mouth technique.
  9. After two rescue breaths, resume compressions.

Repeat the cycle until an ambulance or automated external defibrillator (AED) arrives.

If you have two rescuers, trade-off roles every 4-5 cycles (approximately 2 minutes) to prevent exhaustion. Recheck carotid pulse at this time.

AED

An AED should be applied as soon as it is available. For an adult or a non-breathing child aged 8 or older who weighs more than 55 pounds, perform the following steps without interruption of CPR.

  1. Turn on the AED and follow the visual and/or audio prompts from the machine.
  2. Open the person's shirt and wipe his or her bare chest dry. If the person is wearing any medication patches, you should use a gloved hand or other protective barrier on your hand to remove the patches before wiping the person's chest.
  3. Plug in the AED pads, remove the adhesive backing, and place the pads in the indicated locations on the patient's right upper chest and left lower ribcage.
  4. Tell everyone to "stand clear" and make sure no one is touching the person.
  5. Push the "analyze" button (some models start analysis automatically) and allow the AED to analyze the person's heart rhythm.
  6. If the AED recommends that you deliver a shock to the person, it can take some time to charge. Continue chest compressions while charging.
  7. Once charged, tell everyone to "stand clear" - make sure that no one, including you, is touching the person while the shock is delivered automatically. For some models which do not auto deliver the shock, once the AED is charged and the patient is clear, press the "shock" button.

Restart CPR immediately after the shock was delivered, or if no shock was advised. Perform 2 minutes (about 5 cycles) of CPR and continue to follow the AED's prompts. If you notice obvious signs of life, discontinue CPR and monitor breathing for any changes in condition.

If ALS is not arriving on the scene, most local protocols advise transporting the patient when one of the following occurs:

  • The patient regains a pulse
  • Six to nine shocks have been delivered without Return of Spontaneous Circulation (ROSC)
  • The AED gives three consecutive messages (separated by 2 minutes of CPR) that no shock is advised.

Your local protocol always takes precedence over this general guideline.

For children and infants, there are specialized pads for child and infant AED application, but adult pads should be used if no pediatric pads are available.

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