What is CPR?
CPR stands for Cardiopulmonary Resuscitation. Cardio refers to the heart and pulmonary refers to the lungs. Resuscitate means to revive or rise again. In CPR we pump the heart by doing 30 compressions to circulate the blood, followed by 2 breaths to reoxygenate that blood. CPR is an important technique performed by first aiders when someone’s heart has stopped. It involves two alternating phases: compressions followed by breaths.
When to Do CPR (Cardiopulmonary Resuscitation)?
When a person’s heart stops beating (cardiac arrest), you need to perform CPR (Cardiopulmonary Resuscitation). The simplest way to gauge if someone’s heart is beating effectively is to check if they are breathing. If the person is not breathing, their heart will likely stop beating soon or has already stopped beating.
How do you know if someone is breathing?
To determine if someone is breathing, first, check to see if their chest is rising and falling. Next, listen for breathing sounds as you look over their mouth and nose. Check their breathing for 5-10 seconds.
Why do you perform CPR?
CPR provides a lifesaving opportunity if someone’s heart stops beating effectively. Early CPR doubles or triples the chances of that person surviving. Compressions keep blood circulating throughout the body. Breaths give oxygen to the blood that is circulating.
If someone is unconscious and not breathing, the two biggest factors that will bring them back to life are:
High-Quality CPR
High-quality CPR is composed of two types of lifesaving skills: chest compressions and rescue breaths. The better these skills are performed, the better your chances of surviving.
Early Defibrillation
The earlier AED pads are placed on a person who is unconscious and not breathing, the higher the chance of survival.
How do you perform CPR - Cardiopulmonary Resuscitation
After you suspect a person has gone into cardiac arrest, the next thing that you should do is call 911. If the person is not breathing or has no pulse, you should start CPR. The Canadian Red Cross and the American Heart Association both recommend that CPR should be started for adults who are not breathing. CPR should be started with chest compressions followed by mouth-to-mouth resuscitation.
What are the steps leading up to CPR?
Check scene safety.
Use personal protection (gloves, mask, etc.)
Check if the patient is awake and alive.
Activate EMS (phone 9-1-1).
Check the Scene for safety
Are there any safety hazards? No Fire, no wire, no gas, no glass, no thugs, no bugs.
How many victims are there? Do you see any bystanders that can help?
Can you see the mechanism of injury (MOI)? What happened?
Identify yourself and get consent or implied consent.
When the patient is unconscious it is legally assumed that they consent to receive help. This is called implied consent.
Check the Patient
Check to see if they are awake. Tap their shoulders and shout “Are you okay?”
Check to see if they are alive. Tilt their head back into the head-tilt/chin-lift position and check for breathing by looking for chest rise and fall for 5-10 seconds. If you find someone not breathing or only making gasping sounds, and you don't have an AED on hand, start with chest compressions.
Call for help and Activate EMS (phone 9-1-1). Alert nearby people to come help and tell them to call 9-1-1 and get an AED and to come back to you. If you are alone with the patient, call 9-1-1 on your cell phone and leave it on speaker mode while you provide care to the patient.
Activate EMS (Phone 9-1-1)
It is important to act quickly when someone is having a cardiac arrest, every second counts. Make sure you call 9-1-1 or your local emergency response number as soon as you realize the patient is unconscious.
If you are required to perform CPR, place your phone on speaker mode while speaking with 911 operators. CPR coaching is available over 9-1-1 services.
If you have a bystander with a cell phone
Ask the bystander to activate EMS (phone 9-1-1).
Leave the phone with you on speaker.
Tell the bystander to get an AED and come back.
If you have a bystander but no cell phone
Ask the bystander to find a phone to activate EMS (phone 9-1-1).
Tell the bystander to get an AED and return to the patient.
How to call 9-1-1 when you are alone with a patient
If you are alone with a cellphone
Activate EMS (phone 9-1-1)
Get an AED.
If you are alone with no cell phone
Leave the person to find a phone to activate EMS (phone 9-1-1)
Get an AED and return it to the patient.
How to Perform High-quality CPR
Performing high-quality CPR is an important step in saving a life. It's composed of two types of lifesaving skills: chest compressions and rescue breaths. The better these skills are performed, the better your chances of surviving.
How to perform Chest Compressions during CPR
Compressions work by pumping blood to vital organs such as the brain, heart and other organs. When you push down during compressions, you pump blood to the body. When you allow the chest to recoil to its normal position, blood returns to the heart. Both steps are essential to provide effective chest compressions.
Have the patient lay on their back on a hard surface.
Place the heel of one hand on top of the lower half of the breastbone (sternum). Place the other hand on top of the first hand and lock your fingers.
Tilt your upper body forward so your arms are straight and above the patient’s chest.
Chest compressions are done straight down on the lower half of the breastbone (sternum).
Perform 30 chest compressions and give 2 breaths.
Chest compressions are done at a depth of 5cm (2 inches).
The chest should recoil completely to its normal position between compressions.
Chest compressions are done at a rate of 100-120 compressions per minute.
Interruptions in chest compressions should be less than 10 seconds.
How to Perform Rescue Breaths during CPR
Rescue breathes provide oxygen to the bloodstream which can be circulated to the brain, heart and other vital organs. Yet, if the patient’s heart is not pumping, such as in cardiac arrest, the oxygen you breathe into a patient won't reach the patient’s tissues. Compressions are vital to circulate the recently oxygenated blood with chest compressions.
To provide high-quality breaths you need to:
Tilt the patient’s head back with one hand and lift their chin upward with the fingers of the other hand.
Pinch the patient’s nose closed to prevent air from escaping from the nose.
Place your mouth over the victim’s mouth.
Give 2 breaths. Each breath should be given for about 1 second, just enough to see the chest rise, stop, and let the chest fall back to its resting state.
Two breaths should be given in less than 10 seconds.
How to give breaths with a pocket mask
Open/unfold the pocket mask and assemble the one-way valve, if necessary.
Place the narrow nose grove of the mask on top of the patient’s nose.
Perform a head-tilt/chin-lift
Tilt the patient’s head back.
Place one hand on the top half of the mask.
Place the other hand’s thumb on the bottom half of the mask and use the rest of your fingers to raise the chin up.
Give 2 breaths. Each breath should be given for about 1 second, just enough to see the chest rise, stop, and let the chest fall back to its resting state.
Note - Ensure there is a proper seal on the patient’s face otherwise the breaths will not be effective.
Why Use a Pocket Mask During CPR?
The use of barrier devices helps protect rescuers from body fluids and infection. A pocket mask is preferred over a simple face shield for airborne particles. Using a pocket mask or face shield does not reduce the chance of survival. There is an increased chance of patient survival when giving breaths to a patient when compared to not giving breaths at all.
When you perform CPR on a person and give breaths them, there is minimal risk of infection.
Note: Regular pocket masks and face shields will not protect you against Covid-19. If you are worried about being infected with Covid-19, place a towel, cloth or mask over the patient's mouth and do not provide breaths. Provide compression-only CPR.
Compression-only CPR
The optimal way to perform CPR is with chest compressions and rescue breathing. However, compression-only CPR is almost effective as CPR with compressions and breaths.
When do you perform compression-only CPR?
You believe you may contract an infectious disease from the patient. For example, you do not have a barrier device.
You are uncomfortable performing mouth-to-mouth with the patient.
The patient has special airway complications such as the patient’s jaw being missing.
How To Do Compression-Only CPR
Have the patient lay on their back on a hard surface.
Place the heel of one hand on top of the lower half of the breastbone (sternum). Place the other hand on top of the first hand and lock your fingers.
Tilt your upper body forward so your arms are straight and above the patient’s chest.
Chest compressions are done straight down on the lower half of the breastbone (sternum).
Perform compressions continuously.
Chest compressions are done at a depth of 5cm (2 inches).
The chest should recoil completely to its normal position between compressions.
Chest compressions are done at a rate of 100-120 compressions per minute.
If you are getting tired, have someone else do compressions. A good time to switch is every 2 minutes of CPR, which is after around 200 compressions.
The more tired you are, the less effective compressions become.
Bystanders do not need to be trained in CPR to do compressions. Coach them on how to do compressions effectively while you take a break.
Keep interruptions in chest compressions less than 10 seconds while switching.
Special Considerations when performing CPR
Opioid Overdose
Opioids are prescribed by physicians to relieve pain, for example after surgery. Opioids kill people with respiratory depression and central nervous system depression. Opioids slow down the patient’s breathing to a point where the patient does not breathe and dies. Some opioids include fentanyl, heroin, oxycodone, morphine, and hydromorphone. Naloxone is used to counter the effects of opioid overdose. Naloxone is not a cure, the patient still needs to go to the hospital immediately.
Naloxone
Naloxone, also known as Narcan, is safe to use and free to get at pharmacies in Canada. It is typically found in the nasal spray form with two doses in each Naloxone kit. Naloxone is an effective treatment for opioid overdoses.
Duration of some opioids lasts much longer than naloxone. Repeat doses may be needed. It is safe to give many doses of naloxone every 2-3 minutes, whether they are overdosing on opioids or not. Patients should be monitored in case they relapse into respiratory depression. Additional doses should be given if they relapse into respiratory depression.
How To Use Naloxone For Suspected Opioid Overdose
Nasal Spray:
Tilt the patient’s head back.
Put the white tip into one nostril.
Press the plunger.
Repeat the dose in the other nostril if the desired response is not achieved after 2-3 minutes.
Additional doses (if available) may be given every 2-3 minutes. Alternate nostrils each time.
Pregnant woman
Place a soft object underneath the mother’s right hip. This shifts the weight off of a major vein (inferior vena cava), improving blood return to the heart. This increases blood return to the heart and will allow more blood to be pumped out during compressions.
Keep the shoulders on the floor while her right hip is elevated.
Vomiting
If a patient vomits, grab their head/neck with one hand and their clothes on their hip with the other hand and pull them towards you. Quickly wipe the mouth and continue providing CPR.
Possible reasons why patients vomit during CPR include:
breathing too much air into them
taking too many drugs or ingesting poisons.
Mouth to Nose Breathing
If you can not form a proper seal around the patient’s mouth, you may close their mouth with your hand while breathing through the patient’s nose.
An example of when you may use mouth-to-nose breathing includes when the patient has trauma to their mouth and/or blood is out of their mouth. You may also use this technique when performing CPR on animals.
Preparing a breathing patient for transport with an AED
Patients who have been brought back to life with the help of an AED need to be transported to the hospital for follow-up.
Leave the AED pads attached to the patient. Roll the patient to their side in the recovery position and monitor their airway, breathing, and circulation. Treat them for shock. Document when they collapsed, when CPR started, and when, and how many shocks were given.
How to do Adult CPR
Check the Scene for safety
Are there any safety hazards? No Fire, no wire, no gas, no glass, no thugs, no bugs.
Use personal protection (gloves, mask, etc.)
How many victims are there? Do you see any bystanders that can help?
What happened? Can you see the mechanism of injury (MOI)?
Identify yourself and get consent or implied consent.
When the patient is unconscious it is legally assumed that they consent to receive help. This is called implied consent.
Check the Patient
Check to see if they are awake. Tap their shoulders and shout “Are you okay?”
Check to see if they are alive. Tilt their head back into the head-tilt/chin-lift position and check for breathing by looking for chest rise and fall for 5-10 seconds.
Activate EMS (Phone 9-1-1)
Call for help and activate EMS (phone 9-1-1) and get an AED if the person is unconscious.
If you are alone with the patient, call 9-1-1 on your cell phone and leave it on speaker mode while you provide care to the patient.
If the person is unconscious and not breathing or only making gasping sounds, begin CPR.
If you are alone with the patient, call 9-1-1 on your cell phone and leave it on speaker mode while you provide care to the patient.
Perform High-Quality CPR
Perform 30 Compressions
Have the patient lay on their back on a hard surface.
Place the heel of one hand on top of the lower half of the breastbone (sternum). Place the other hand on top of the first hand and lock your fingers.
Tilt your upper body forward so your arms are straight and above the patient’s chest.
Chest compressions are done straight down on the lower half of the breastbone (sternum).
Perform 30 chest compressions and give 2 breaths.
Chest compressions are done at a depth of 5cm (2 inches).
The chest should recoil completely to its normal position between compressions.
Chest compressions are done at a rate of 100-120 compressions per minute.
Interruptions in chest compressions should be less than 10 seconds.
Give 2 Breaths
Tilt the patient’s head back with one hand and lift their chin upward with the fingers of the other hand.
Pinch the patient’s nose closed to prevent air from escaping from the nose.
Place your mouth over the victim’s mouth.
Give 2 breaths. Each breath should be given for about 1 second, just enough to see the chest rise, stop, and let the chest fall back to its resting state.
Two breaths should be given in less than 10 seconds.
Repeat 30 compressions and 2 breaths until:
When someone else takes over (paramedics, bystanders, etc.).
Whenever the patient’s condition changes, reassess the patient and check to see if they are breathing. Stop CPR if the patient is breathing.
If the patient starts to move or make noises, they may be alive, reassess the patient.
If the patient vomits, roll them on the side and scoop out the rest of the vomit and then reassess the patient.
When the scene becomes unsafe.
When you are too exhausted to continue.
When AED initially arrives on the scene you may stop CPR to quickly place the pads on the patient.
Use an AED as soon as it arrives
The AED pads will show you to place one AED pad on the right chest and left armpit. The chance of survival decreases significantly for every minute delay in the AED reaching the patient.
Turn on the AED and follow the prompts. The AED will tell you everything you need to do. It has pictures to show you where to place the pads. The AED comes with a razor to shave hairy chests, scissors to cut clothes, and a cloth to wipe off sweat. The AED will say the following:
Call 911.
Remove clothing from the patient’s chest.
Apply pads to the patient’s bare chest.
Plug in the pads connector (if required).
When two pads are placed on the chest the AED will tell you to not touch the patient while it analyzes the heart’s condition.
If the AED finds a rhythm it can shock it will tell you to stand clear and press the flashing shock button. If the patient is not breathing, continue CPR. If the patient is breathing, stop CPR.
If the AED finds a rhythm it can not shock it will tell you to continue CPR.
Every 2 minutes the AED will reanalyze for a shockable rhythm.
Top 3 Most Common Mistakes Performing Chest Compressions
PERFORMING CHEST COMPRESSIONS TOO FAST. won't allow the heart to fully refill with blood.
Not pushing deep enough. Won’t circulate blood effectively (or at all).
Leaning your weight on top of them and not allowing the chest to fully recoil. Won't allow the heart to fully refill with blood
Top 3 Most Common Mistakes Performing Rescue Breaths
Giving breaths too long, too hard, and/or too fast. This will result in air being pumped into the stomach and the patient vomiting. May also damage the lungs.
Not tilting the head back. The tongue will slide back to physically block the airway and air will not enter the lungs.
Not pinching the nose. the air will escape through the nose and into your face instead of the patient’s lungs.
Top 3 Most Common Mistakes Using an AED
Reaching across the body to press the shock button. If you accidentally touch the patient while you press the button, you will be shocked and your heart will stop. Have the patient beside you.
Placing the AED pads in the wrong position. The pads have pictures of where you should place the AED pads on the body. Follow the directions.
Not saying “clear” when pressing the shock button. If you don’t yell “clear” and someone is touching the body when you press the shock button, their heart will stop and now you may have two patients to do CPR on.
Child CPR
Who is a Child?
A child is anyone who is older than 12 months and has not reached puberty (around 12 years old). When in doubt as to whether the child has reached puberty, treat them as an adult.
How Does Child CPR Differ from Adult CPR?
Child CPR is similar to adult CPR with only a few differences.
You may use one or two hands for compressions during child CPR. If you believe you won't be able to provide high-quality chest compressions before help arrives, it is better to use two hands during CPR. For children, you must do compressions that are about 1/3 the chest depth, which is about 5 cm (2 inches).
The most common mistake for child CPR is that rescuers don’t push deep enough. It is better to push too hard than not hard enough.
Children and infants usually have healthy hearts. Breathing problems are often the cause of a child or infant needing CPR. It is therefore more important to give children breaths than it is to give adults breaths.
If you are alone with a child with no cell phone and no bystanders, you should provide 5 cycles (about 2 minutes) of CPR before activating EMS (phone 9-1-1).
Since respiratory problems are often the cause of cardiac arrest in children. Children will respond better to being oxygenated by your breaths than an adult would.
Children have smaller lungs and need less air blown into them to make their chests rise during CPR.
Causes of Breathing Emergencies in Children
Children experience respiratory distress due to respiratory infections, an illness (asthma, allergic reactions, etc.) or a blocked airway (choking). Additionally, children may have breathing problems due to injuries such as broken ribs and drowning or swallowing poisons such as household cleaning products and medications.
Safety measures to prevent breathing emergencies in children
Breathing emergencies are a cause of concern for both children and infants. The following are safety measures to prevent breathing emergencies in children and infants:
If you have children, childproof your home. Inspect your home for any choking hazards, especially lower areas that they can easily reach. Make sure to keep cribs free of toys and excess blankets.
To help prevent breathing emergencies, never let toddlers and children eat anything without supervision. Children should also be fed a diet consisting of appropriate foods including specifically avoiding anything that's a choking hazard such as popcorn or nuts while they are under the age of four. Do not allow children or infants to run while eating.
Do not allow children to play with balloons unsupervised. Make sure your toys don’t have loose pieces they can choke on.
How does Child AED Protocol Differ from Adult AED Protocol?
Look for a child switch or child key on the AED if available.
Use child AED pads if available. If child AED pads are not available, use adult AED pads but make sure they do not come into contact with each other. There must be at least 1 inch (2.5cm) separation between the pads.
If the AED pads don’t have an inch separation, place one AED pad on the chest and another AED pad on the back.
How to do Child CPR
Check the Scene for safety
Are there any safety hazards? No fire, no wire, no gas, no glass, no thugs, no bugs.
Use personal protection (gloves, mask, etc.)
How many victims are there? Do you see any bystanders that can help?
What happened? Can you see the mechanism of injury (MOI)?
Identify yourself and get consent or implied consent.
When the patient is unconscious it is legally assumed that they consent to receive help. This is called implied consent.
Check the Patient
Check to see if they are awake. Tap their shoulders and shout “Are you okay?”
Check to see if they are alive. Tilt their head back into the head-tilt/chin-lift position and check for breathing by looking for chest rise and fall for 5-10 seconds.
Activate EMS (Phone 9-1-1)
Call for help and activate EMS (phone 9-1-1) and get an AED if the person is unconscious.
If you are alone with the child, call 9-1-1 on your cell phone and leave it on speaker mode while you provide care to the patient.
If you are alone with a child with no cell phone and no bystanders, you should provide 5 cycles of CPR before activating EMS (phoning 9-1-1).
If the person is unconscious and not breathing or only making gasping sounds, begin CPR.
Perform High-Quality Child CPR
Perform 30 Compressions
Have the patient lay on their back on a hard surface.
Place the heel of one hand on top of the lower half of the breastbone (sternum). Place the other hand on top of the first hand and lock your fingers.
Tilt your upper body forward so your arms are straight and above the patient’s chest.
Chest compressions are done straight down on the lower half of the breastbone (sternum).
Perform 30 chest compressions and give 2 breaths.
Chest compressions are done at a depth 1/3 of the chest depth, approximately 5cm (2 inches).
The chest should recoil completely to its normal position between compressions.
Chest compressions are done at a rate of 100-120 compressions per minute.
Interruptions in chest compressions should be less than 10 seconds.
Give 2 Breaths
Tilt the patient’s head back with one hand and lift their chin upward with the fingers of the other hand.
Pinch the patient’s nose closed to prevent air from escaping from the nose.
Place your mouth over the victim’s mouth.
Give 2 breaths. Each breath should be given for about 1 second, just enough to see the chest rise, stop, and let the chest fall back to its resting state.
Two breaths should be given in less than 10 seconds.
Repeat 30 compressions and 2 breaths until:
When someone else takes over (paramedics, bystanders, etc.).
Whenever the patient’s condition changes, reassess the patient and check to see if they are breathing. Stop CPR if the patient is breathing.
If the patient starts to move or make noises, they may be alive, reassess the patient.
If the patient vomits, roll them on the side and scoop out the rest of the vomit and then reassess the patient.
When the scene becomes unsafe.
When you are too exhausted to continue.
When AED initially arrives on the scene you may stop CPR to quickly place the pads on the patient.
Use an AED as soon as it arrives
Use child pads if the child is less than 8 years old (if available). The AED pads will show you to place one AED pad on the center of the child’s chest and the other on the center of the child’s back. The chance of survival decreases significantly for every minute delay in the AED reaching the patient.
If a patient is defibrillated quickly, the chance of survival increases significantly
Turn on the AED and follow the prompts. The AED will tell you everything you need to do. It has pictures to show you where to place the pads. The AED comes with a razor to shave hairy chests, scissors to cut clothes, and a cloth to wipe off sweat. The AED will say the following:
Call 911.
Remove clothing from the patient’s chest.
Apply pads to the patient’s bare chest (front and back).
Plug in the pads connector (if required).
When two pads are placed on the child the AED will tell you to not touch the patient while it analyzes the heart’s condition.
If the AED finds a rhythm it can shock it will tell you to stand clear and press the flashing shock button. If the patient is not breathing, continue CPR. If the patient is breathing, stop CPR.
If the AED finds a rhythm it can not shock it will tell you to continue CPR.
Every 2 minutes the AED will reanalyze for a shockable rhythm.
Infant CPR
Who is an infant?
Anyone who is younger than 12 months old is an infant.
Causes of Breathing Emergencies in Infants
Infants experience respiratory distress due to respiratory infections, an illness (asthma, allergic reactions, etc.) or a blocked airway (choking). Additionally, injuries may have breathing problems due to injuries such as broken ribs and drowning or swallowing poisons such as household cleaning products and medications.
Safety measures to prevent breathing emergencies in children
Breathing emergencies are a cause of concern for both children and infants. The following are safety measures to prevent breathing emergencies in children and infants:
If you have children, childproof your home. Inspect your home for any choking hazards, especially lower areas that they can easily reach. Make sure to keep cribs free of toys and excess blankets.
To help prevent breathing emergencies, never let toddlers and children eat anything without supervision. Children should also be fed a diet consisting of appropriate foods including specifically avoiding anything that's a choking hazard such as popcorn or nuts while they are under the age of four. Do not allow children or infants to run while eating.
Do not allow children to play with balloons unsupervised. Make sure your toys don’t have loose pieces they can choke on.
How Does Infant CPR Differ from Adult CPR?
Infant CPR is similar to adult CPR with only a few differences.
You may use two fingers for compressions during infant CPR. If you believe you will be tired before help arrives, and you won't be able to provide high-quality chest compressions, it is better to use two thumbs during CPR. For an infant, you must do compressions that are about 1/3 the chest depth, which is about 4 cm (1.5 inches).
The most common mistake in infant CPR is that rescuers don’t push deep enough. It is better to push too hard than not hard enough.
Do NOT rest your body weight on the baby.
Infants have flexible airways. If you bend the infant’s head back too much the upper airway will kink closed. Instead, you want to tilt the infant’s head back only a little so that the nose is in the highest position (sniffing position). The airway should stay in this neutral position while giving breaths.
Do NOT have the chin in the highest position, it will kink the airway.
Infants have healthy hearts unless they were born prematurely or with a genetic predisposition. Breathing problems are a common cause of an infant needing CPR. It is therefore more important to give infants breaths than it is to give adults breaths.
If you are alone with an infant with no cell phone and no bystanders, you should provide 5 cycles (about 2 minutes) of 30 compressions and 2 breaths before activating EMS (phoning 9-1-1).
Since respiratory problems are often the cause of cardiac arrest in infants. Infants will respond better to being oxygenated by your breaths than an adult would.
Infants have smaller lungs and need less air blown into them to make their chests rise during CPR.
Perform two small puffs when giving breaths. Fill your cheeks with air and release that air over the infant's nose and mouth.
Do NOT forcefully exhale
How does Infant AED Protocol Differ from Adult AED Protocol?
Look for a child switch or child key on the AED if available.
Use child AED pads if available. If child AED pads are not available, use adult AED pads but make sure they do not come into contact with each other. There must be at least 1 inch (2.5cm) separation between the pads.
If the AED pads don’t have an inch separation, place one AED pad on the chest and another AED pad on the back.
How to do Infant CPR
Check the Scene for safety
Are there any safety hazards? No fire, no wire, no gas, no glass, no thugs, no bugs.
Use personal protection (gloves, mask, etc.)
How many victims are there? Do you see any bystanders that can help?
What happened? Can you see the mechanism of injury (MOI)?
Identify yourself and get consent from the parents/guardians or implied consent.
When the patient is unconscious it is legally assumed that they consent to receive help. This is called implied consent.
Check the Patient
Check to see if they are awake. Tap their shoulders and shout “Are you okay?”
Check to see if they are alive. Tilt their head back into the head-tilt/chin-lift position and check for breathing by looking for chest rise and fall for 5-10 seconds.
Activate EMS (Phone 9-1-1)
Call for help and activate EMS (phone 9-1-1) and get an AED if the person is unconscious.
If you are alone with the infant, call 9-1-1 on your cell phone and leave it on speaker mode while you provide care to the patient.
If you are alone with an infant with no cell phone and no bystanders, you should provide 5 cycles of CPR (about 2 minutes) before activating EMS (phoning 9-1-1).
If the infant is unconscious and not breathing or only making gasping sounds, begin CPR.
Perform High-Quality Infant CPR
Perform 30 Compressions
Have the infant lay on its back on a hard surface.
Place the two fingers in the center of the chest, below the nipple line and above the abdomen (stomach).
Have your fingers vertically above the infant.
Chest compressions are done straight down on the lower half of the breastbone (sternum).
Perform 30 chest compressions and give 2 breaths.
Chest compressions are done at a depth 1/3 of the chest depth, approximately 4cm (1.5 inches).
The chest should recoil completely to its normal position between compressions.
Chest compressions are done at a rate of 100-120 compressions per minute.
Interruptions in chest compressions should be less than 10 seconds.
Give 2 Breaths
Tilt the infant’s head back with one hand into the sniffing position where the nose is the highest position (neutral position). Lift the infant's chin upward with the fingers of the other hand.
Place your mouth over the infant’s nose and mouth.
Give 2 puffs. Fill your cheeks with air and release only what is in the cheeks. Give enough breath to see the chest rise, stop, and let the chest fall back to a resting state.
Two breaths should be given in less than 10 seconds.
Repeat 30 compressions and 2 breaths until:
When someone else takes over (paramedics, bystanders, etc.).
Whenever the infant’s condition changes, reassess the patient and check to see if they are breathing. Stop CPR if the infant is breathing.
If the patient starts to move or make noises, they may be alive, reassess the patient.
If the patient vomits, roll them on the side and scoop out the rest of the vomit and then reassess the patient.
When the scene becomes unsafe.
When you are too exhausted to continue.
When AED initially arrives on the scene you may stop CPR to quickly place the pads on the patient.
Use an AED as soon as it arrives
Use child/infant pads if available. The AED pads will show you to place one AED pad on the center of the infant’s chest and the other on the center of the infant’s back. The chance of survival decreases significantly for every minute delay in the AED reaching the patient.
If an infant is defibrillated quickly, the chance of survival increases significantly
Turn on the AED and follow the prompts. The AED will tell you everything you need to do. It has pictures to show you where to place the pads. The AED comes with a razor to shave hairy chests, scissors to cut clothes, and a cloth to wipe off sweat. The AED will say the following:
Call 911.
Remove clothing from the patient’s chest.
Apply pads to the patient’s bare chest (front and back).
Plug in the pads connector (if required).
When two pads are placed on the infant the AED will tell you to not touch the patient while it analyzes the heart’s condition.
If the AED finds a rhythm it can shock it will tell you to stand clear and press the flashing shock button. If the patient is not breathing, continue CPR. If the patient is breathing, stop CPR.
If the AED finds a rhythm it can not shock it will tell you to continue CPR.
Every 2 minutes the AED will reanalyze for a shockable rhythm.