NCM 106 SKILLS

PERFORMING CARDIOPULMONARY RESUSCITATION: ADULT & INFANT

DEFINITIONS
Casualty - is the person with the medical problem, such as a person who is not breathing.
When being treated by medical personnel, the casualty may be referred to as a patient.

Rescuer - is the person who is assisting the casualty; for example, the person giving mouth-tomouth resuscitation to a casualty who is not breathing.

Airway - consists of the body structures through which air from the atmosphere passes while
going to the lungs.

CARDIOPULMONARY RESUSCITATION

Is a basic emergency procedure for life support

It consists of artificial respiration and manual external cardiac massage

It is used to establish circulation and ventilation to prevent irreversible brain damage

resulting from anoxia.

BASIC LIFE SUPPORT

Does not require the use of any equipment although mechanical devices may be used
It can be done with one or two people and involves three interrelated activities: opening
airway, restoring breathing, and restoring circulation.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 The three signs of cardiac arrest are apnea (absence of respirations), absence of carotid or
femoral pulse, and dilated pupils.

PERFORMANCE ERRORS/ COMPLICATIONS OF CPR:

Complications associated with CPR include the following:

Improper hand position during cardiac compressions can cause rib fracture
Failure to adequately ventilate the client due to improper head position can lead to
hypoxia and gastric distention.

Poor oxygen profusion to vital organs may result in brain and tissue damage.
The body attempts to maintain homeostasis by shunting circulation to vital organs,
resulting in less perfusion to the periphery, which can result in distal tissue damage.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Critical Aspects
Establish whether the patient is unresponsive. (Shake the patient and shout, Are you
OK?)

Activate the emergency response system immediately if the patient is an adult. If you are
alone and the patient is an infant or child, perform CPR for 1 minute, and then activate the
emergency response system.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 Carefully place the patient on a hard surface. Logroll the patient if you suspect a cervical
spine injury. If the patient is in a hospital bed, place a CPR board under the patients back.

Properly position yourself.

PERFORMING CARDIOPULMONARY RESUSCITATION
ONE AND TWO PERSON

Critical Aspects
A Airway. Open the patients airway. Use either the head tilt chin lift maneuver or
the jaw thrust maneuver.

B Breathing. Check for breathing. (Place your ear over the patients mouth and nose.

Look, listen, and feel for breathing for no longer than 10 seconds.) If the patient is
breathing, continue to hold the airway open. If the patient is not breathing, administer two
(2) slow breaths.

C Circulation. Check for signs of circulation. Use the carotid pulse in adults and

children, and the brachial or femoral pulse in infants. Assess for pulse for 5 to 10 seconds.
Also check for other signs of circulation, such as movement.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Critical Aspects
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 If signs of circulation are absent , correctly position your hands and begin chest
compressions.

Continue CPR for four cycles, then reassess pulse.

Stop CPR if the patient responds, regains an adequate pulse, and begins to breath; if you
are too exhausted to continue; or if signs of death are obvious.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

EQUIPMENT:
Resuscitation bag with mask, mouth shield, or face mask with one way valve.
Oxygen source, if available
Chest compression board or hard surface
PERFORMING CARDIOPULMONARY RESUSCITATION
ONE AND TWO PERSON

ASSESSMENT:

Assess the following:

Airway. Assess the patients level of consciousness.
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 R: Assessing the patients level of consciousness prevents administering CPR to a patient

who is sleeping or has depressed level of consciousness.

Breathing. Assesses for airway patency and breathing.

Circulation.
Injury can result if CPR is administered on a patient who doesnt require it.
PERFORMING CARDIOPULMONARY RESUSCITATION
ONE AND TWO PERSON

ASSESSMENT:

Assess the following:

Determine (preferably in advance of an emergency) whether the patient has an advance
directive stating that he does or does not wish to have CPR performed.

Monitor the effectiveness of chest compressions and ventilations.

R: Ineffective chest compressions and ventilations can have detrimental effects on the
patient.

Assess the patients cardiac and respiratory status after cardiac rhythm and respirations
are restored.

The patients condition is typically unstable after an arrest; therefore, careful, frequent
assessment of the cardiac and respiratory systems is necessary to quickly detect
deterioration in patients status.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

PROCEDURE:
1. Establish whether the patient is unresponsive by shaking him and shouting Are you OK?

R: Unresponsiveness must be determined to avoid performing CPR on a patient who

might be sleeping or have a decreased level of consciousness.

2. Activate the emergency response system immediately if the patient is an adult. If you are
alone and the patient is an infant or child, perform CPR for 1 minute, and then activate the
emergency response system.

R: Activating the emergency response system immediately ensures that advanced life
support equipment such as a defibrillator, airway management equipment, and IV
medication are on the way for use.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

PROCEDURE:
3. Carefully place the patient on a hard surface. Logroll the patient if you suspect a cervical
spine injury. If the patient is in a hospital bed, place a CPR board under the patients back.

R: A hard surface is necessary to provide chest compression adequately. Logrolling the

patient maintains stability of the cervical spine should a cervical spine injury be present.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

PROCEDURE:
4. Properly position yourself.
Variation: One person CPR

Position yourself on the floor, with your knees parallel to the patients sternum.
R: This position requires the least amount of body movement when you switch from
compressions to ventilation.
Variation: Two Person CPR

Position yourself on the floor, with your knees parallel to the patients sternum. The
second person should position himself on the opposite side of the patient, with his knees
parallel to the patients sternum. If the patient is in a hospital bed, stand with your body
parallel to the patients sternum.

R: Positioning one person on each side of the patient allows one person to deliver chest
compressions while the other person ventilates the patient.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

5. Open the patients airway.

Variation: Head- Tilt Chin - Lift Maneuver

Place one hand on the patients forehead, and apply firm pressure, tilting the patients
head back.
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 R: Tilting the patients head back helps open the airway.

Place the fingertips of your other hand under the patients chin, and lift his chin. Keep the
patients mouth partially open.

R: This maneuver pulls the base of the tongue away from the back of the throat
maintaining an open airway.

HEAD-TILT-CHIN-LIFT MANUEVER
PERFORMING CARDIOPULMONARY RESUSCITATION
ONE AND TWO PERSON

5. Open the patients airway.

Variation: Jaw Thrust Maneuver

Kneel at the patients head, with your elbows on the floor. Place your thumbs on his
lower jaw near the corners of the mouth.

R: Placing thumbs on the lower jaw near the corners of the mouth prepares you to lift the
lower jaw to pull the open the airway.

Place your fingers around the lower jaw, and lift the lower jaw with your fingertips.
R: This maneuver pulls the base of the tongue away from the back of the throat,
maintaining an open airway while protecting the cervical spine.

JAW THRUST MANUEVER

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

6. While keeping the airway open, check for breathing by placing your ear over the patients
mouth and nose. Look, listen, and feel for breathing for no longer than 10 seconds.

R: Assesses the patients ability to move air into and out of the lungs. Cardiac arrest can
occur independently of respiratory arrest, at least initially.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

7. If the patient is breathing or resumes effective breathing, continue to hold the airway open.
Alternatively, if the patient is not breathing, administer two (2) slow breaths.

R: You should initiate two slow breaths immediately if the patient isnt breathing to
provide the patient with much needed oxygen.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Variation: Adult (Adolescent and Older)

a. Pinch the patients nose with your thumb and fingers. Place your mouth, the mouth
shield, or the face mask over the patients mouth.

R: Prevents air from escaping through the nares when you deliver a breath.
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 b. Deliver two breaths into the patients mouth, allowing 1 second per breath. Move your
mouth or mask to allow the patient to exhale between breaths. Deliver subsequent breaths
at a rate of 10 to 12 breaths per minute.

R: allowing 1 second per breath allows the adults lungs to expand appropriately and
ensures adequate oxygen delivery.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Variation: Child (1 to Adolescent)

a. Pinch the childs nose with your thumb and fingers. Place your mouth, mouth shield, or
the face mask over the childs mouth.

R: Prevents air from escaping through the nares when you deliver a breath.
b. Delivering two breaths over 1 second per breath allows the childs lungs to expand
appropriately and ensures adequate oxygen delivery.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Variation: Infant (Less than 1 year of age)

a. Place your mouth over the infants mouth and nose, forming a seal.
R: A seal keeps air from escaping through the nares when you deliver a breath.
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 b. Deliver two breaths (very gentle puffs) into the infants nose and mouth, allowing 1
second per breath. Allow the infant to exhale between breaths. Deliver subsequent breaths
at a rate of 12 20 breaths/ minute.

R: delivering two breaths over 1 second per breath allows the infants lungs to expand
appropriately and ensures adequate oxygen delivery.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

8. Check for signs of circulation, using the carotid pulse in adults and children and the brachial
or femoral pulse in infants. Assess for a pulse for 5 to 10 seconds. Also check for other signs of
circulation, such as movement.

R: lets you know whether chest compressions are indicated. Chest compressions are

indicated when the pulse is absent in the adult or is less than 60 beats per minute in the
infant. Check the pulse for 5 to 10 seconds, because the pulse may be present but difficult
to detect if it is slow, irregular, weak, or rapid.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

9. If signs of circulation are absent, correctly position your hands, and begin chest
compressions. If a second person is present, the second person should assess the pulse while the
first person performs compressions.

R: Correct hand placement prevents patient injury. Allowing the second person to check
for pulse helps assesses the effectiveness of CPR.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Adult:

1. Place the heel of one hand over the lower half of the sternum, and place your other
hand on top of the first hand, locking them in position.

2. Compress 1 to 2 inches at a rate of 100 compressions per minute.

R: The chest must be compressed 1 to 2 inches to ensure adequate circulation and
prevent patient injury.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

Child:

1. Place the heel of one hand over the lower half of the sternum.
2. Compress 1/3 to the depth of the chest at a rate of 100 compressions per minute.
R: The chest must be adequately compressed to ensure adequate circulation and to
prevent injury.
PERFORMING CARDIOPULMONARY RESUSCITATION
ONE AND TWO PERSON

Infant:
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

 1. Place two finger breadth below the intermammary line.

R: Because the chest is small, fingers are used to prevent compressing too forcefully, as
could occur if you used the hand.

2. Compress 1/3 to the depth of the chest at a rate of at least 100 compressions per
minute, 120 compressions per minute in the newborn.

R: The chest must be adequately compressed to ensure adequate circulation and to

prevent injury.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

10. Continue ventilating the patient.

Variation: Adult

The second rescuer should administer the ventilations, making sure to deliver the breath
as the rescuer administering compressions pauses between compressions.

Note: The ratio for compressions to ventilations is 15:2 for two persons and 30: 2 for one
person CPR in adult. The person performing chest compressions must pause momentarily
to allow the second person to deliver ventilations.

R: Pausing to deliver ventilations ensures adequate delivery of ventilations. This

technique delivers 10 to 12 breaths per minute and approximately 100 compressions per
minute.
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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

10. Continue ventilating the patient.

Variation: Child and Infant

Administer two breaths for every 30 compressions with a single rescuer and 2 breaths per
15 compressions with two rescuers.

R: This technique delivers about 20 breaths per minute and 100 compressions per minute.
PERFORMING CARDIOPULMONARY RESUSCITATION
ONE AND TWO PERSON

11. Continue CPR for four cycles, and then reassess pulse.

R: Reassessing pulse prevents administering CPR inadvertently to the patient who

doesnt require it.

12. Stop CPR if the patient responds, regains an adequate pulse, and begins to breath; if you are
too exhausted to continue; or if signs of death are obvious.

R: CPR should be continued only as needed. Part of administering CPR responsibly is

knowing when to stop the procedure when the patients condition becomes hopeless.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

EVALUATION

After the airway is opened, monitor for the return of spontaneous respirations.
Evaluate the effectiveness of ventilations and chest compressions.
PATIENT TEACHING

Instruct the family and caregivers where they can receive CPR training and certification
if the patient is at risk for experiencing cardiopulmonary arrest.

Explain the importance of keeping emergency phone numbers readily available in the
event of an emergency.

PERFORMING CARDIOPULMONARY RESUSCITATION

ONE AND TWO PERSON

HOME CARE

Activate the emergency response team by dialing 911 in the community setting or by
dialing an other designated emergency number if the 911 service is not available.

Make sure the patient is on a firm surface before administering CPR.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION

DOCUMENTATION

Document the date and time the arrest occurred.

Document whether the patient experienced cardiac or respiratory arrest or both.
Record the events surrounding the arrest, such as the location of the patient when the
arrest occurred, precipitating factors, who discovered the patient, and whether the arrest
was witnessed.

Document who initiated CPR.

Record the name of the physician notified.
Record the length of time in which the patient received CPR.
Document any complications and the patients response to CPR.
Record all information on the designated code record if the arrest occurred within the
hospital setting, including medications given and procedures performed.

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01. NCM 106 SKILLS - CARDIOPULMONARY RESUSCITATION