Chapter 5: Adult CPR, AED, and Choking

Video 5a: Adult CPR
Script: Welcome to the lesson on Adult CPR. In this video, we will go through the steps of Adult CPR.

CPR is comprised of chest compressions, airway management, and rescue breathing. To deliver high-quality CPR, begin with high-quality chest compressions. Compressing the chest circulates blood to the brain and the heart. Chest compressions should be delivered at a rate between 100 to 120 beats per minute and depth of 2 to 2.4 inches (that is, 5 to 6 cm).

To provide CPR to any adult, the first thing to do is to make sure the scene and area around the individual is safe.

Then, tap them and talk loudly asking if they’re okay.

Yell for help. Use a cellphone to call 911 and send a bystander to get an AED.

Check the individual’s breathing.

If the individual is not responding, breathing, or only gasping, start CPR.

Give 30 compressions at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (that is, 5 to 6 cm). Let the chest rise back up before the next compression.

Open the airway to give two breaths.

This concludes our lesson on Adult CPR. Next, we will discuss Compressions.


Video 5b: Compressions
Script: Welcome to the lesson on Compressions. In this video, we will review the steps of giving chest compressions.

Compressions should always be given at a rate of 100 to 120 beats per minute and at a depth of 2 to 2.4 inches (that is, 5 to 6 cm). Compressing the chest slower than 100 beats per minute is less likely to provide enough circulation to the brain, heart, and other vital organs; and compressing faster than 120 beats per minute doesn’t provide enough time for the heart to fill between each compression, which reduces the output as well. Similarly, pressing the chest deeper than 2.4 inches (that is, 6 cm) increases the risk of injuring the individual; and not pressing deep enough will not squeeze the heart enough to provide adequate blood flow.

CPR always begins with compressions, and then breaths. Rescuers who are uncomfortable performing mouth-to-mouth and do not have a mask may perform hands-only CPR and give compressions.

For high-quality chest compressions, first position the individual on their back on a firm, flat surface.

Then, remove or open up clothing at the neck and chest area.

Feel for the end of the breastbone (or the sternum).

Place the heel of one hand on the lower half of the breastbone. Avoid pressing down on the very end of the breastbone as the bony tip, known as the xyphoid process, may break off and slash the liver, resulting in internal bleeding. Put the other hand on top of the first hand.

Press straight down at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (that is, 5 to 6 cm).

Let the chest rise up completely between compressions. Your hands should remain in contact with the individual, without bouncing or leaning on them.

Proper CPR can be tiring. Ask to switch positions when tired, if another rescuer is available to help.

This concludes our lesson on Compressions. Next, we will review Giving Breaths.


Video 5c: Giving Breaths
Script: Welcome to the lesson on Giving Breaths. In this video, we will review the steps of giving breaths.

Giving breaths during CPR can help maintain a supply of oxygen in the lungs. Oxygen, in turn, is circulated to the brain and to the vital organs by chest compressions. The preferred method is to use a mask; however, mouth-to-mouth can also be performed. A correctly executed breath will cause the individual’s chest to rise.
To open the individual’s airway, first put one hand on their forehead.

Place your fingers on the bony part of their chin.

Then, gently tilt the head back while lifting the chin.

Next step is to give breaths. To do so, hold the individual’s airway and pinch their nose shut.

Then, take a deep breath and seal your mouth around their mouth.

Blow into their mouth for one second and watch their chest rise.

Repeat with a second breath.

If the chest doesn’t rise, reposition the airway. Let their head go back to a normal position and then repeat the head-tilt-chin-lift maneuver. Then, give another breath and watch for the chest to rise.

Perform chest compressions without interruptions. It should take no longer than 10 seconds to give two breaths. If the chest fails to rise within 10 seconds, begin chest compressions again. If the individual is suspected of trauma, the jaw-thrust maneuver should be performed to open the airway instead of the head-tilt-chin-lift maneuver.

To perform the jaw-thrust maneuver, place the index and middle fingers to physically push the lower jaw upwards while the thumb is used to push down on the chin to open the mouth.

This concludes our lesson on Giving Breaths. Next, we will review Mask Use.


Video 5d: Mask Use
Script: Welcome to the lesson on Mask Use. In this video, we will review the steps of using a mask.

CPR, including giving breaths, is generally safe. If a mask is available, you should use it. The mask fits over the individual’s mouth and nose. Most masks have a pointed end, which should go over the bridge of the nose.

To use a mask to give breaths, first place the mask over their mouth and nose.

Then, open the airway by performing the head-tilt-chin-lift maneuver.

Ensure a good seal between the mask and the individual’s face.

Give a breath for over one second and watch the chest rise.

Deliver the second breath.

This concludes our lesson on Mask Use. Next, we will review AED for adults.


Video 5e: AED for Adults
Script: Welcome to the lesson on AED for Adults. In this video, we will discuss the steps of using an AED.

AED, or automated external defibrillator, is a portable unit that has a computer that analyzes the heart rhythm and determines if a shock is needed. An AED can deliver a shock to help restart the heart. Starting CPR immediately and quickly using an AED improves the chances of survival.

The AED is very simple to use--just follow the diagram or voice instructions given by the AED. It should be used anytime someone collapses, fails to respond, and is only gasping, or barely breathing.

First, turn the power on.

Expose the chest and apply pads on the chest. (If they have a medication patch on their chest, remove it before applying the AED pads. If there’s a bulge under the skin of their chest, a pacemaker may be present. Avoid placing the AED over the pacemaker and adjust placement accordingly.)

Connect the pads.

Analyze the rhythm.

Follow the prompts on the AED. The prompts include Shock Advised, No Shock Advised, and Check Connection. If you are giving a shock, make sure no one is touching the individual.

Resume CPR with compressions.

If the AED malfunctions or does not work, continue performing CPR until additional help arrives. If an AED is not quickly available, begin CPR, and send someone to locate an AED.

This concludes our lesson on AED for Adults. Next, we will discuss Activating EMS.

Video 5f: Activating EMS
Script: Welcome to the lesson on Activating EMS. In this video, we will discuss the importance of calling 911 and what to do meanwhile.

Immediate activation of EMS, or emergency medical services, by dialing 911 or the appropriate emergency number is the first step in the Chain of Survival.

Use a speaker-equipped cell phone to activate EMS, so you don’t have to leave the individual who needs care. In situations when a cell phone is not available, send a second rescuer or a bystander to call 911, so the ill/injured individual is not left alone. In case there is no one around to help and you don’t have access to a speaker-equipped cell phone, then go call 911 and get an AED yourself.

Make sure the scene is safe when approaching the individual. Tap their shoulders and ask them if they are okay. If they do not respond or react, they are considered unresponsive. Yell for help and immediately call 911.

Stay on the phone until the operator tells you it’s okay to hang up. The operator can help you make decisions and will not delay the arrival of additional help.

Check the individual’s breathing. If they are barely breathing or only gasping, begin CPR. If they are breathing normally but not responding, roll them onto their side. This can help keep their airway open and prevent them from choking on their own vomit. Monitor their breathing and be prepared to start CPR if the condition worsens.

This concludes our lesson on Activating EMS. Next, we will review Choking in Adults.


Video 5g: Choking in Adults
Script: Welcome to the lesson on Choking in Adults. In this video, we will discuss choking in adults and signs of choking to look for.

Choking is a preventable cause of death that occurs when food or another object gets stuck in the throat. The airway gets blocked and immediate action is needed.

A choking individual typically only has a few minutes before they pass out. The universal sign of choking is holding the neck with one or both hands.

Refer to Table 1 in the CPR manual for details on degree of obstruction, signs of choking, and actions you should take depending on the situation.

This concludes our lesson on Choking in Adults. Next, we will review Relief of Choking.


Video 5h: Relief of Choking
Script: Welcome to the lesson on Relief of Choking. In this video, we will discuss the steps of the abdominal thrusts and chest thrusts.

Abdominal thrusts, or the Heimlich maneuver, is used in adolescents and adults. To perform the Heimlich maneuver, stand behind the individual and wrap your arms around their waist under the ribcage.

Then, put your fist above their navel in the middle of the belly.

With your other hand, hold the first fist and press forcefully into the abdomen and up toward their chest.

Continue performing thrusts until the obstruction is relieved or until the individual becomes unresponsive. If they become unresponsive, then begin CPR.

Very large individuals or pregnant women can be treated with chest thrusts. To perform chest thrusts, wrap both arms around the individual, as you would in the Heimlich maneuver. Then, pull your arms straight back to deliver the chest thrusts.

If the individual has passed out due to choking, help them to the ground and immediately begin CPR. If there’s a bystander, send them to call 911. If there’s no one around to help, then perform CPR for two minutes, and then go get help yourself.

When opening the airway to give breaths during CPR, check for the obstruction in the airway. If you see it and can easily remove it, then remove it with your fingers. If you can’t see it, or it cannot be removed, then continue CPR.

This concludes our lesson on Relief of Choking. Next, we will look at introduction to Child CPR.