CPR Technical Manual: Thunwa Klaihathai, Vivian Le, Aishu Reddy, Cameron Thomas
CPR Technical Manual: Thunwa Klaihathai, Vivian Le, Aishu Reddy, Cameron Thomas
CPR Technical Manual: Thunwa Klaihathai, Vivian Le, Aishu Reddy, Cameron Thomas
Manual
Thunwa Klaihathai, Vivian Le,
Aishu Reddy, Cameron Thomas
1
T H E
HISTORY OF CPR
A B R I E F O V E R V E I W ¹
1767
Amsterdam's Society for Recovery
of Drowned Persons first
community initiative to deliver
1892 first aid in sudden death
German doctors publish paper situations.¹
documenting first case of chest
compression as a resuscitation
technique.¹⁸ 1959
Dr. James Elam releases instructional
booklet and films titled "Rescue
Breathing" for general public and
1960
medical professionals.²⁵
"Closed-Chest Cardiac Massage"
published in Journal of the
American Medical Association,
marking the origin of modern
CPR technique.²⁰ 1963
American Heart Association
endorses CPR as a
1966 lifesaving measure.¹
The National Academy of
Sciences announces the first
national guidelines for practical
use and training of CPR.¹ 1972
Dr. Leonard Cobb organizes the
first large-scale CPR training
program for citizens, training over
2015-Present
100,000 people in Seattle,
AHA releases the Guidelines for
Washington.¹⁷
CPR and ECC (Emergency
Cardiovascular Care), the current
national recommendations, with
2017 and 2018 updates.¹ 2
"Anyone, anywhere, can
initiate cardiac resuscitative
procedures. All that is
needed are two hands"²⁰
Source: FCC-Winchester.com
3
CHAPTER 2
CPR FOR DIFFERENT PEOPLE
How to identify
who needs CPR¹⁵
People who need
CPR are usually:
4
CPR for Adults¹²
This type of CPR is for people who are 8 years old or older.
5
To begin chest compressions, place the heel of
5 your hand, one on top of the other, in the middle
of the chest. Use your body weight to push down
on the chest, making sure the compressions are
at least 2 inches deep.
- Compressions should be delivered at a rate of 100-120
compressions per minute.
Source: giving.greenhosp.org
Source: central-laborers.com
6
Check to see if their chest rises, then
8 administer another breath, If their chest does
not rise, re-tilt their head and blow again.
7
CPR for Children¹³
This type of CPR is for children who are between 1-8 years old.
Source: cprcertificationtrainingonline.com
8
If the child is not breathing, tilt their head back,
4 make sure their chin is up, pinch their nose,
open their mouth, and administer 2 rescue
breaths.
- Each breath should be about 1 second long.
Source: central-laborers.com
9
Place the heel of your hand, one on top of the
7 other, in the middle of their chest. Then use
your body weight to push down on the chest,
making sure the compressions are about 2
inches deep and delivered at a rate of 100-120
compressions per minute.²²
Source: doctoryouneed.com
10
CPR for Infants⁶
This type of CPR is for infants less than 1 years old.
Source: onestepatatime.co.za
11
Check their pulse by:
3
- Using 2 fingers and place it on their brachial artery.
- Press down gently for 5-10 seconds to feel for a pulse.
Source: onestepatatime.co.za
Source: myhealth.alberta.ca
12
Begin chest compressions.
5
- One-man: Place 2 fingers in the middle of their chest
(between their nipples) and push down about 1 1/2 inches
deep. Finger compressions must be fast, similar to child
and adult compressions. 30 finger chest compressions
should be given followed by 2 rescue breaths.
- Two-man: Each person gives 15 finger chest
compressions followed by 2 breaths.
Source: nationalcprassociation.com
13
calling 911⁸
Why is it important to call 911?
Often, people are afraid or hesitant to call 911
because they are not sure if it is a real
emergency. By calling 911, you are activating
the Emergency Medical Support (EMS) system.
Calling 911 is the most important step you can
take in an emergency because the fast arrival
of medical help greatly increases a person’s
chance of surviving a life-threatening
emergency. Some facilities and locations in
the United States will require you to dial a
certain number in order to get an outside line
6
before you can dial 9-1-1. Other locations may
not have access to a 9-1-1 system and use a
local emergency number instead. It is
important to familiarize yourself with your
location so that you know what emergency
number to call to get help.
14
when to call
911⁸
Call if the person is experiencing any
of the following conditions:
Unconsciousness or an altered level of
unconsciousness such as drowsiness or confusion
Breathing problems (little or no breaths)
Chest pain or any discomforting pressure lasting
more than a few minutes and radiates to the
shoulder, arm, neck, jaw, stomach, or back
6
Persistent abdominal pain
Has no pulse
Severe bleeding
Vomiting blood
Severe burns
Suspected poisoning
Spinal injury
15
steps for calling 911⁸
Make sure the scene is safe. Then place them on
1 a flat, hard, and dry surface.
equipment manufacturers. ²¹
18
AED Precautions
In the case of cardiac arrest, immediately call 9-1-1
or the local emergency number and begin CPR. If
CPR is in progress, do not interrupt until AED is
available and turned on, and defibrillation pads
have been applied.
Always follow manufacturer’s operating
instructions.
Do not use an AED and/or pads designed for
adults on a child younger than 8 years or weighing
less than 55 pounds unless pediatric AED pads
specific to the device are not available.
Do not use pediatric AED pads on an adult or on a
child older than 8 years, or on a person weighing
more than 55 pounds.
Make sure no one is in contact with the person
when the AED is analyzing or defibrillating.
Do not use or keep any alcohol or flammable
products when defibrillating.
Do not use an AED in a moving vehicle. Movement
may affect the analysis.
Do not use a mobile phone or radio within 6 feet of
the AED. Interference from radio signals can
disrupt analysis. ⁶
19
AED Usage
General AED Instructions for Adults, Children, and Infants
1. Turn on AED
-If an adult or child over 8 years old or above 55lbs, place one
pad on the upper right chest and the other pad on the left side of
the chest.
-If a child under 8 years old or less than 55lbs or an infant, use
pediatric pads. Place one pad on the child’s upper right chest and
the other pad on the left side of the chest. If the pads risk
touching each other, place one pad in the middle of the child’s or
infant’s chest and the other pad on the child’s or infant’s back,
20
AED Usage
General AED Instructions for Adults, Children, and Infants
5. Stand Clear
7. Deliver shock
8. Perform CPR
-If two trained people are available, one should operate the AED
21
Special AED Situations
AEDs Around Water
If person is in water, remove them from the water, take off wet clothing,
and dry the person’s chest before defibrillating. If raining or snowing, try to
keep the person as dry as possible, but do not delay the AED process.
If the implanted device is visible or you know that the person has one, do
not place the defibrillation pads directly over the device. This may
interfere with the delivery of the shock. Instead, adjust pad placement if
Chest Hair
With excessive chest hair, a “check pads” message may appear on the AED.
If so, remove the pads, shave the chest hair using the safety razor provided
22
Special AED Situations
Metal Surfaces
If AED is being delivered to a person on a metal surface, make sure pads are
Leaving them on will do no harm. Removing will only delay the AED process.
Trauma
If the person in cardiac arrest has suffered severe trauma, it is still safe to use
Hypothermia
If the person is not breathing, begin CPR until and AED is available. Follow
23
AED Maintenance
Follow the manufacturer’s specific
recommendations and your facility’s schedule for
periodic equipment checks
Make sure that the batteries have enough energy
for one complete rescue. (Always have a fully
charged backup battery available.)
Make sure that the correct defibrillation pads are
in the package and not expired. Replace if
expired.
Ensure that all accessories are replaced after use.
If at any time the machine fails to work properly
or warning indicators are recognized, stop using
it and contact the manufacturer immediately.
If the AED stops working during an emergency
continue performing CPR until EMS personnel
take over.⁶
24
CHAPTER 4
AN INTRODUCTION TO CHOKING
the universal
sign of choking
Also known as the
Universal Distress Signal,
it is when a person
clutches throat with one
or both hands⁶
25
CHOKING
Other Signs and Symptoms
Inability to speak
Difficulty breathing
Loss of consciousness
Pale skin ²⁹
26
Respiratory Respiratory
vs.
Arrest Distress
Regular, strong Increased breathing rate
heartbeat but no Color changes on skin to
breathing gray/pale, blueish colors
Nerves, muscles of the around mouth
body are not capable Grunting sounds every
of supporting time person exhales
respiration Nostril flaring, body
No need for chest works harder to get air
compressions or CPR, into lungs
no need for Retractions: chest
defibrillator appears to sink in just
Successful below the neck or under
management comes breastbone with each
from ventilation²⁶ breath
Sweating: increased
sweat on head but skin is
not warm, skin may feel
cool or clammy
Wheezing, tight whistling
sound with each breath
Body position may lean
forward, sign of
collapse²⁸
27
The Heimlich Maneuver
For Adults:
1. Make a fist with one hand
2. Put thumb side of fist slightly above
the belly button and well below the
breastbone
3. Grasp the fist with other hand and
give quick upward thrust into abdomen
4. Give thrusts until the object is forced
out²⁹
28
For Children (Over 1 Year):
29
For Babies (Under 1 Year):
1. Place baby face down on forearm,
supporting neck and chin with fingers, tilt
hand so head is lower than chest
2. Give 5 quick blows between shoulder
blades, using heel of hand
If no object comes out, turn baby over and
place faceup on table or floor
3. Place two fingers
in middle of breastbone
just below nipple and
give 5 quick thrusts
6. Repeat cycle of 5
back blows and 5
chest thrusts until
object comes out
7. If baby becomes
unconscious, begin
CPR immediately³⁰
Source: Saint Luke's Health System
30
For Pregnant Women and
Obese Individuals:
1. Position hands a bit
higher than normal,
at base of breastbone
just above the
joining of the
lowest ribs
2. Proceed with
regular Heimlich
maneuver,
pressing hard Source: Modern First Aid
31
CHAPTER 5
CPR CERTIFICATION
WHO SHOULD GET
CPR CERTIFIED?
The Answer: Everyone!
m o c. R P C e l l i v x o n K : e c r u o S
Ralph Harms, 78, was playing golf with his son Joe and friend Doug Green on July
30, 2013. After a great shot at the fourth hole, Ralph remembers hollering, “Yeah,
baby.” The next thing he remembers is waking up in the hospital three days later.
Ralph had collapsed on the course in full cardiac arrest just seconds after that
great shot. Though he says he was familiar with the signs and symptoms of a heart
attack, “cardiac arrest is like walking up to a light switch and just turning it off,” he
says. “There was no warning.”
About four years prior, Ralph and Joe were watching a football game together on
T.V. When a commercial about CPR came on, Ralph asked his son if he was
certified. Ralph had taken Red Cross CPR classes every two years for decades in
order to keep his CPR certification active. His son had not yet done the same, and
Ralph recalls getting on the floor to show Joe the proper way to do chest
compressions. “It’s a good thing Joe remembered—or I wouldn’t be here,” Ralph
says.
While his friend Doug called 9-1-1 with a cell phone, Joe began CPR. With
paramedics en route, Ralph’s heart started and stopped three times. All the while,
Joe continued chest compressions. Ralph miraculously survived and spent three
days in a drug-induced coma. Ralph knows it was his friend and son’s efforts and
the CPR know-how that contributed to his survival.⁹
33
Taking It To Distance
When Todd Tewksbury
set out for his routine
daily jog back in August
of 2014, everything about
it felt normal from lacing
up his cross-trainers to
the feel of his old t-shirt.
He couldn’t have known
that in just a few
minutes and a few miles,
his life was about to
change forever and if
not for some quick
Source: 123RF.com
thinking onlookers, he
may have lost it entirely.
Of course, how could he have known? There was no reason to consider that
as he approached JFK by the art museum on his typical path, he would suffer
from cardiac arrest and fall to his knees. After all, Todd, a 27-year-old athlete,
had no reason to consider something like heart failure could even happen to
him, let alone that it would find himself suddenly slumped on all fours that
summer day along the waterfront
Dr. Aaron Mendelson and his wife were a few yards away when they rushed to
Todd’s side upon seeing him fall to the ground, Once they reached him
however, it became evident that he did not have a pulse and they knew it had
to be a heart issue. Arron and his wife were very well trained in the emergency
care of cardiac arrest and began to administer CPR in attempt to provide
Tewksbury’s vital organs the oxygen they desperately needed.
The group with him on the waterfront administered CPR for a total of 11
minutes at which point two women brought over a defibrillator, delivering a
lifesaving dose of electric current in order to start his heart back up. Todd is
alive and well today and is incredibly grateful to the Mendelson’s and others
that stepped in and took action that day. It was incredibly lucky that there
were trained medical professionals within the general vicinity of where the
incident occurred, however, Dr. Mendelson says that anyone could have
done what he did to save Todd’s life.¹⁴
34
Off The Deep End
m o c. R P C t n a f n I : e c r u o S
The Lassiter family The Lassiter family had When Riley was found
was out for an been treading water for and taken out of the
afternoon of leisure nearly 25 minutes water her tiny body was
and fun that turned according to reports limp and she was not
into an almost tragic taken by the Florida Fish breathing. Michael Kirk
event when the small and Wildlife Conservation instantly began
boat they were on Commission. Shelby performing CPR on the
was overcome by the Lassiter held onto their 4 infant; Riley started
rough waves and year old son, Bowen, breathing, but not with
knocked the two while Russell Lassiter normal breaths. Shelby
adults and their two clung to their 9 month and Riley were both
small children off into old baby, Riley. Michael transported by
the ocean. About a Kirk, the boat captain, emergency technicians
mile away there was a and his crew were able to to the local hospital for
charter boat captain toss a rope to Shelby and further treatment.
taking four guests out her son to rescue them. Thankfully, because of
for a boating ride But Russell and the baby the rapid response of
when he noticed the were still about 100 feet Michael Kirk and his crew
small ship had away. Russell was yelling the Lassiter family is
disappeared beneath for help, and Michael Kirk healing now and baby
the waves. He could see him in the Riley is on the road to a
summoned one of his water but not the infant. full recovery. Once again,
crew to call 911 as he It was at this time that a the act of CPR has saved
headed to the scene mayday was issued for another person.¹⁹
of the incident. the missing infant.
35
H O W T O G E T
CPR
CERTIFIED
S T E P - B Y - S T E P
8. 1.
Pass the test and Identify why you
you're officially want to get CPR
CPR certified! certified
7. 2.
Take a CPR Research the
certification test over history and current
competencies and standing/guidelines
techniques for CPR
6. 3.
Practice! Search for CPR
Study hard to be sure training options.
you can demonstrate Classes can be
CPR proficiency done online or
in-person
5. 4.
Complete all training Decide on a training
modules and method that fits best
activities to learn for you and your
proper CPR schedule
technique
36
BEST PLACES TO GET
CPR CERTIFIED
01
AMERICAN HEART
ASSOCIATION
The American Heart Association is at the forefront
of CPR science, education and training. ⁴ They
educate over 22 million people each year, offering
both in-person CPR training centers and online
Source: Heart.org
eLearning courses, which can be found at ⁵
https://cpr.heart.org/AHAECC/CPRAndECC/FindA
Course/UCM_473162_Find-A-Course.jsp³
02
AMERICAN RED
CROSS FOUNDATION
The American Red Cross is the premier organization
Source: Forbes.com
for emergency preparedness and response.¹ ⁰ They
offer an online locator to find upcoming CPR
trainings in your local area, which can be found at
https://www.redcross.org/take-a-class/cpr¹¹
37
References
1. American Heart Association. History of CPR timeline.
2015; https://newsarchive.heart.org/history-of-cpr-timeline-text-only/.
2. American Heart Association. What is CPR?
2018; https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRECC/WhatIsCPR/UC
M_499896_What-is-CPR.jsp.
3. American Heart Association. CPR & first aid training classes.
2018; https://cpr.heart.org/AHAECC/CPRAndECC/FindACourse/UCM_473162_Fin
d-A-Course.jsp.
4. American Heart Association. CPR and ECC.
2018; https://cpr.heart.org/AHAECC/CPRAndECC/UCM_473161_CPR-and-
ECC.jsp.
5. American Heart Association. CPR facts and stats.
2018; https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRECC/CPRFactsAndS
tats/UCM_475748_CPR-Facts-and-Stats.jsp.
6. American Red Cross. First Aid/CPR/AED participant’s manual.
2011; https://www.redcross.org/content/dam/redcross/atg/PHSS_UX_Content/F
A-CPR-AED-Part-Manual.pdf.
7. American Red Cross. Pediatric first aid/CPR/AED. 2011.
8. American Red Cross. American Red Cross First Aid/CPR/AED. In: Cross
TANR, ed. Fourth
ed.2014: https://www.redcross.org/content/dam/redcross/atg/PHSS_UX_Conten
t/FA-CPR-AED-Part-Manual.pdf.
9. American Red Cross. CPR saves: Stories from the red cross.
2016; https://www.redcross.org/about-us/news-and-events/news/CPR-Saves-
Stories-from-the-Red-Cross.html.
10. American Red Cross. Mission & values.
2018; https://www.redcross.org/about-us/who-we-are/mission-and-values.html.
11. American Red Cross. CPR training. 2018; https://www.redcross.org/take-a-
class/cpr.
12. American Red Cross. CPR steps. 2018; https://www.redcross.org/take-a-
class/cpr/performing-cpr/cpr-steps.
References
13. American Red Cross. Child and Baby CPR.
2018; https://www.redcross.org/take-a-class/cpr/performing-cpr/child-baby-cpr.
14. Bodie E. Joggers life was about to change.
2016; https://inpulsecpr.com/joggers-life-change.html.
15. Center for Disease Control and Prevention. Three things you may not
know about CPR. In: Services USDoHH, ed. USA2018.
16. Cleveland Clinic. Heart health survey 2017. 2017.
17. Eisenberg MS. Leonard Cobb and medic one. Resuscitation.2002;54(1):5-9.
18. Figl M, Pelinka LE, Mauritz W. Franz Koenig and Friedrich
Maass. Resuscitation. 2006;70(1):6-9.
19. Jenkins T. Pensacola boat sinks, child pulled from water lifeless.
2018; https://inpulsecpr.com/pensacola-boat-sinks-child-pulled-from-water-
lifeless.html.
20. Kouwenhoven WB, Jude JR, Knickerbocker G. Closed-chest cardiac
massage. JAMA. 1960;173(10):1064-1067.
21. Mayo Clinic. Automated external defibrillators: Do you need an AED?
2017; https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/in-
depth/automated-external-defibrillators/art-20043909.
22. Mayo Clinic Staff. Cardiopulmonary resuscitation (CPR): First aid.
2018; https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600.
23. National CPR Foundation. How much does a CPR class cost?
2018; https://www.nationalcprfoundation.com/how-much-does-a-cpr-class-cost/.
24. Onderko P. How to do the Heimlich maneuver on your child.
2018; https://www.parenting.com/article/how-to-do-the-heimlich-maneuver-on-
your-child. Accessed December 2, 2018.
25. Sands MDRobert P, Bacon MDMADouglas R. An inventive mind: The
career of James O. Elam, M.D. (1918–1995). Anesthesiology.1998;88(4):1107-1112.
26. Smith B. Why everyone should get CPR certified this semester.
2016; https://www.public-health.uiowa.edu/why-everyone-should-get-cpr-
certified-this-semester/.
References
27. Staff A. Respiratory arrest.
2018; https://www.aclsmedicaltraining.com/respiratory-arrest/. Accessed
December 2, 2018.
28. Staff H. Heimlich maneuver for adults and children older than 1 year.
2018; https://www.uofmhealth.org/health-library/tf7235. Accessed December 2,
2018.
29. Staff JH. Learning the signs of respiratory distress.
2018; https://www.hopkinsmedicine.org/healthlibrary/conditions/respiratory_dis
orders/signs_of_respiratory_distress_85,P01326. Accessed December 2, 2018.
30. Staff MC. Choking: First aid. 2017; https://www.mayoclinic.org/first-aid/first-
aid-choking/basics/art-20056637. Accessed December 2, 2018.