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muscle. If the pulse is present, ventilate as necessary. If the pulse is absent, locate the sternum and begin chest compressions. PROPER POSITIONING OF HANDS ON STERNUM.—To locate the sternum, use the middle and index fingers of your lower hand to locate the lower margin of the victim’s rib cage on the side closest to you (fig. 4-14). Then move your fingers up along the edge of the rib cage to the notch where the ribs meet the sternum in the center of the lower chest. Place your middle finger on the notch and your index finger next to it. Place the heel of your other hand along the midline of the sternum next to your index finger. Remember to keep the heel of your hand off the xiphoid (tip of the sternum). A fracture in this area may damage the liver, causing hemorrhage and death. CHEST COMPRESSIONS.—Place the heel of one hand directly on the sternum and the heel of the other on top of the first. Interlock your fingers or extend them straight out and KEEP THEM OFF THE VICTIM’S CHEST! Effective compression is accomplished by locking your elbows into position, straightening your arms, and positioning your shoulders directly over hands so that the thrust for each chest compression is straight down on the sternum. See figure 4-15. The sternum should be depressed approximately 1 ½ to 2 inches (for adults). Release c h e s t c o m p r e s s i o n p r e s s u r e b e t w e e n e a c h compression to allow blood to flow into the chest and heart. When releasing chest compression pressure, remember to keep your hands in place on the chest. Not only will you feel less fatigue if you use the proper technique, but a more effective compression 4-19 Figure 4-13.—Locating the carotid pulse. Figure 4-14.—Proper position of hands on the sternum for chest compressions. Figure 4-15.—Proper position of the rescuer.


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