Before you start chest compression be sure that chest compression are needed. CPR is known for breaking ribs in adult patients and we certainly don’t want to do that if that is not what is needed. So how will you know if that is what is needed? For starters, the victim needs to be unresponsive. This means they do not respond to any auditory or physical stimulus. The classic tap on the shoulder and shouting “are you ok?” is part of the primary assessment and should always be done prior to doing any CPR.
If the victim responds to any type of stimulus, this would imply that they are still alive and the heart is functioning. It does not mean that they are not in trouble; it just means that you should not be doing CPR on that person. Victims of cardiac arrest DO NOT respond to any stimulus, so be careful to check real good prior to starting CPR.
Before doing chest compressions you should also be looking for breathing. Consistent breathing is a better indication of a working heart then checking a pulse. The keyword here is “consistent” breathing. Even if it is slow, if it is consistent it means that the heart is working and CPR is not needed. Remember, when you are doing chest compressions you are manually pumping the heart. If the victim is consistently breathing on their own, their “pump” is working automatically and you do not need to pump it.
Finding the pulse on an unconscious victim can be challenging even for experienced health care providers. Currently, industry standards do not recommend lay responders check the pulse of adult patients. However, if you are a professional or you know how to check a pulse, it can be done very easily while you check for breaths. Can you have breathing with no pulse? The answer is YES. While you cannot have breathing without a working heart, the pulse may not be "palpable" or "unable to be felt" in some circumstances. Take for example a large victim with a high percentage of body fat around the neck and a low blood pressure. Even experienced professionals will have a challenge finding a pulse. If the victim is breathing “consistently” (even if it is slow) their heart is working. A lot of people struggle with this reality.
Many times overdose victims and victims of diabetic coma look like they are dead. However, a careful assessment may reveal that they are in fact breathing. If that is the case, the best position for them may be in the recovery position of their side until EMS arrives (unless you are EMS)
While assessment priorities are the same with children and infants as with adult, starting chest compressions on a child or infant is appropriate anytime you have no breathing and no pulse, OR a pulse with a rate of less then 60 beats per minute. It is not enough to have a pulse for an unresponsive child or infant who is not breathing. They must have a pulse with a rate of at least one beat per second in order to sustain life.
Always assess carefully prior to doing chest compressions on anybody. Patient assessment is a skill in itself and one that should be understood clearly before the application of any treatment like chest compressions.
American Red Cross, American Heart Association (AHA), and American Health and Safety Institute guidelines. Instructors available on site.
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