will also result. Ineffective compression occurs whenthe elbows are not locked, the rescuer is not directlyover the sternum, or the hands are improperly placedon the sternum.PERFORMANCE AND REASSESSMENT OFCPR.—When one rescuer performs CPR, the ratio ofcompressions to ventilations is 15 to 2, and it isperformed at a rate of 80 to 100 compressions perminute. Vocalize: “one and, two and, three and,...”until you reach 15. After 15 compressions, you mustgive the victim two slow ventilations (1 ½ to 2seconds). Continue for four full cycles. Quickly checkfor the carotid pulse and spontaneous breathing. Ifthere are still no signs of recovery, continue CPR withcompressions. Reassess the patient every few minutesthereafter.If a periodic check reveals a return of pulse andrespiration, discontinue CPR and place the victim inthe recovery position. Continue monitoring the victimand be prepared to restart CPR .Two-Rescuer CPRIf there are two people trained in CPR on the scene,one should perform chest compressions while the otherperforms ventilations. The compression rate fortwo-rescuer CPR is the same as it is for one-rescuerCPR: 80 to 100 compressions per minute. However,the compression-ventilation ratio is 5 to 1, with a pausefor ventilation of 1 ½ to 2 seconds consisting primarilyof inspiration. Exhalation occurs during chestcompressions.Two-rescuer CPR should be performed with onerescuer positioned at the chest area and the other positionedbeside the victim’s head. The rescuers should be onopposite sides of the victim to ease position changes whenone rescuer gets tired. Changes should be made on cuewithout interrupting the rhythm.The victim’s condition must be monitored to assessthe effectiveness of the rescue effort. The personventilating the patient assumes the responsibility formonitoring pulse and breathing. To assess theeffectiveness of the partner’s chest compressions, therescuer should check the pulse during compressions. Todetermine if the victim has resumed spontaneousbreathing and circulation, chest compressions must bestopped for 5 seconds at the end of the first minute (20cycles) and every few minutes thereafter.NOTE: Although it has fallen out to favorwith some agencies, two-person CPR remainsa viable method of resuscitation.CPR for Children and InfantsCPR for children (1 to 8 years old) is similar to thatfor adults. The primary differences are that the heel ofonly one hand is used to apply chest compressions, andventilations are increased to a rate of 20 breaths perminute (once every 3 seconds). Chest compressionsare performed on the lower half of the sternum(between the nipple line and the notch). The chestshould be depressed approximately one-third toone-half (about 1 to 1 ½ inches) the total depth of thechest.For infants (under 1 year old), CPR is performedwith the infant supine on a hard, flat surface. The hardsurface may be the rescuer’s hand or arm, althoughusing the arm to support the infant during CPR enablesthe rescuer to transport the infant more easily whilecontinuing CPR. See figure 4-16. Once the infant ispositioned on a hard surface, the airway should beopened using the head tilt-chin lift or jaw-thrustmaneuver. Both maneuvers, however, must beperformed very carefully and gently to preventhyperextension of the infant’s neck. Pulselessness isdetermined by palpating the brachial artery (fig. 4-17).If the infant has no pulse and is not breathing, CPRmust be started immediately.To perform CPR on an infant, place your mouthover the infant’s nose and mouth, creating a seal. Givetwo slow breaths (1 to 1 ½ seconds per breath) to theinfant, pausing after the first breath to take a breath.Pausing to take a breath after the first breath of eachpair of breaths maximizes oxygen content and4-20Figure 4-16.—Infant supported on rescuer’s arm, and properplacement of fingers for chest compressions.
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