muscle. If the pulse is present, ventilate as necessary.If the pulse is absent, locate the sternum and beginchest compressions.PROPER POSITIONING OF HANDS ONSTERNUM.—To locate the sternum, use the middleand index fingers of your lower hand to locate thelower margin of the victim’s rib cage on the side closestto you (fig. 4-14). Then move your fingers up along theedge of the rib cage to the notch where the ribs meet thesternum in the center of the lower chest. Place yourmiddle finger on the notch and your index finger nextto it. Place the heel of your other hand along themidline of the sternum next to your index finger.Remember to keep the heel of your hand off thexiphoid (tip of the sternum). A fracture in this area maydamage the liver, causing hemorrhage and death.CHEST COMPRESSIONS.—Place the heel ofone hand directly on the sternum and the heel of theother on top of the first. Interlock your fingers orextend them straight out and KEEP THEM OFF THEVICTIM’S CHEST!Effective compression isaccomplished by locking your elbows into position,straightening your arms, and positioning yourshoulders directly over hands so that the thrust for eachchest compression is straight down on the sternum.See figure 4-15. The sternum should be depressedapproximately 1 ½ to 2 inches (for adults). Releasec 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 hcompression to allow blood to flow into the chest andheart. 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 theproper technique, but a more effective compression4-19Figure 4-13.—Locating the carotid pulse.Figure 4-14.—Proper position of hands on the sternum forchest compressions.Figure 4-15.—Proper position of the rescuer.
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