American Red Cross certified corpsman, nurse, or physician.
The rescuer must not assume that an arrest has occurred solely because the victim is lying on the floor and appears to be unconscious. First, try to arouse the victim by gently shaking the shoulders and trying to obtain a response; (loudly ask: “Are you O.K.?”). If there is no response, place the victim supine on a firm surface. Kneel at a right angle to the victim, and open the airway using the head tilt or jaw thrust methods described previously. Attempt to ventilate. If unsuccessful, reposition the head and again attempt to ventilate. If still unsuccessful, deliver four abdominal or chest thrusts to open the airway. Repeat the thrust sequence until the obstruction is removed.
Once the airway has been opened, check for the carotid pulse. The carotid artery is most easily found by locating the larynx at the front of the neck and then sliding two fingers down the side of the neck toward you. The carotid pulse is felt in the groove between the larynx and the sternocleidomastoid muscle. If the pulse is present, ventilate as necessary. If the pulse is absent, locate the sternum and begin closed cardiac massage.
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. 4-18A). The fingers are then moved up along the edge of the rib cage to the notch where the ribs meet the sternum in the center of the lower chest (fig. 4-18B). The middle finger is placed on the notch and the index finger is placed next to it. The heel of the other hand is placed along the midline of the sternum next to the index finger (fig. 4-18C). Remember to keep the heel of your hand off the xiphoid tip of the sternum. A fracture in this area can damage the liver, causing hemorrhage and death.
Place the heel of one hand directly on the sternum and the heel of the other on top of the first (fig. 4-18D). Interlock your fingers or extend them straight out and KEEP THEM OFF THE VICTIM’S CHEST!
Lean or rock forward with the elbows locked and apply vertical pressure to depress the sternum (adult) 1 1/2 to 2 inches. Then release the pressure, keeping the hands in place on the chest.
You will feel less fatigue if you use the proper technique and a more effective compression will result. Ineffective compression occurs when the elbows are not locked, the rescuer is not directly over the sternum, or the hands are improperly placed on the sternum.
When one rescuer performs CPR, as shown in figure 4-19, the ratio of compressions to ventilation is 15 to 2, and it is performed at a rate of 80 compressions per minute to maintain 60 full compression each minute. Vocalize: “one and, two and, three and, . . .” until you reach 15. After 15 compressions, you must give the victim 2 ventilation. Continue for four full cycles. Quickly check for the carotid pulse and spontaneous breathing. If there are still no signs of recovery, continue CPR. If a periodic check reveals a return of pulse and respiration, discontinue CPR, but closely monitor the victim and be prepared to start CPR again if required.
Before learning the next technique, review the steps to take for a cardiac arrest involving one rescuer.
1. Determine whether the victim is conscious.
2. Check vital signs.
3. Ventilate two times (it may be necessary to remove an airway obstruction at this time).
4. Again check vital signs; if there are none, begin the compression-ventilation rate of 15 to 2 for four complete cycles.
5. Check pulse, breathing, and pupils; if there is no change, continue the compression-ventilation rate of 15 to 2 until the victim is responsive, you are properly relieved, or you can no longer continue.
Two Rescuer Technique If there are two people trained in CPR on the scene, one must perform compression while the