CPR

CARDIOPULMONARY RESUCITATION
DEFINITION
• is an emergency procedure that combines chest compressions
and ventilation in an effort to manually preserve intact brain
function until further measures are taken to restore
spontaneous blood circulation and breathing in a person who
is in cardiac arrest. It is recommended in those who are
unresponsive with no breathing or abnormal breathing.
• It is a simple inexpensive procedure that can be learned by
anyone and consists of 4 main parts:
Chest compressions, Airway, Breathing, and Defibrillation
• It requires no special medical skill and training is available
for the ordinary person
• If effectively done immediately after cardiac arrest, it can
double a victim’s chance of survival
5 EMERGENCY ACTION PRINCIPLES
1. SCENE SAFETY
2. ACTIVATE MEDICAL ASSISTANCE
3. INITIAL/PRIMARY ASSESSMENT OF THE VICTIM
4. SECONDARY ASSESSMENT OF THE VICTIM
5. REFERRAL FOR FURTHER EVALUATION AND
MANAGEMENT
 I. SCENE SAFETY – SURVEY THE SCENE
Once you recognized that an emergency has occurred
and you decide to act, you must make sure the scene of
the emergency is safe for you, the victim’s, and any
bystander/s. Always make sure the area is safe. You don’t
want to be a victim yourself or add more injury to the
scene.
Elements of the Survey the Scene
 Scene safety.
 Mechanism of injury or nature of illness.
 Determine the number of patients and
additional resources.
II. ACTIVATE MEDICAL ASSISTANCE
(AMA) OR TRANSFER FACILITY

Both trained and untrained bystanders

should be instructed to Activate
Medical Assistance as soon as they
have determined that an adult victim
requires emergency care “Call First”.
While for infants and children a “Care
First” approach is recommended.
 WHAT TO REPORT
What happened?
Location
Information of person/s involved; age, gender
Number of Persons Injured
Extent of Injury and First Aid given
The telephone number from where you are calling?
Person who activated Medical Assistance must identify
him/herself and drop the phone last
III. INITIAL/PRIMARY ASSESSMENT OF THE
VICTIM
Response. Check if the victim is responsive or
unresponsive. As you approach them, introduce
yourself and ask them questions to see if you can
get a response. Kneel next to their chest and gently
shake their shoulders, asking, ‘What has
happened?’, ‘Open your eyes!’ “hey, hey, are you
okay?”
WHAT TO DO IN GIVING EMERGENCY CARE
Do remember to identify yourself
Do obtain consent when possible
Do think of the worst
Do provide comfort and emotional support
Do respect the victim (modesty and privacy)
Do be as calm and direct as possible
Do care for the most serious injuries first
Do assist the victim on medication
Do keep on lookers away from the injured person
Do handle the victim to a minimum
Do loosen tight clothing
 DON’TS IN GIVING EMERGENCY CARE
× Do not leave the victim alone except to get help
× Do not assume that the victim’s obvious injuries
are the only one
× Do not make any unrealistic promises
× Do not trust the judgment of a confused person
× Do not let the victim see his/her injuries
× Do not revive a victim with valid DNR (do not
resuscitate) order
 IV. SECONDARY ASSESSMENT OF THE VICTIM
It is a methodical check to assess a responsive casualty for any other injuries
or illnesses.
• Once you have completed a primary survey and treated any life-threatening
conditions, move on to a secondary survey. Ask a responsive victim and
those around them questions about any incident that may have occurred.
Your aim is to find out more about the casualty’s history, signs and
symptoms. If possible, take note of their answers.
• Leave the victim in the position found until you are satisfied that it is safe to
move them into a position more suitable for their injury or illness.
 History Taking – find out more about the victim’s history.

~SAMPLE
Signs – look, listen, feel and smell ~for any signs of injury such as swelling, deformity,
bleeding, discoloration or any unusual smells. When checking them you should always
compare the injured side of the body with the uninjured side. Are they able to perform
normal functions such as standing or moving their limbs? As you check, make a note of
any superficial injuries to treat once you’ve finished your examination.

Symptoms – ask the casualty short, simple questions about any symptoms and
sensations they may be feeling. They should answer in as much detail as possible. For
example, ask them:
• Do you have any pain?
• Where is the pain?
• When did the pain start?
• Can you describe the pain, is it constant or irregular, sharp or dull?
Allergy – Do they have any allergies? For example, nuts or any
medication such as penicillin or aspirin?

Medication – are they taking any medication?

Previous medical history – do they suffer from any medical condition
such as diabetes, epilepsy or heart disease? Have they had any previous
injuries or surgery?

Last meal – when did they last eat or drink?

Event history – what happened and where? Is the incident due to an
illness or an accident? Ask any people nearby what happened and look
for any clues that may give you more information.
IV. REFERRAL FOR FURTHER EVALUATION &
MANAGEMENT

It refers to the transfer of a

victim to a hospital or health
care facility if necessary for
definitive treatment.
 CHAIN OF
SURVIVAL

The original four links of the chain of survival

comprised:
1. EARLY ACCESS
2. EARLY HIGH QUALITY CPR
3. EARLY DEFIBRILLATION
4. EARLY ADVANCED LIFE SUPPORT (ALS)
EARLY ACCESS — It is the event initiated after the
patient’s collapse until the arrival of Emergency Medical Services
(EMS) personnel prepared to provide care.

EARLY HIGH QUALITY CPR — It is most effective when

started immediately after the victim’s collapse. The probability of
survival approximately doubles when it is initiated before the
arrival of EMS. It aims to slow the rate of deterioration of the
brain and heart, and buy time to enable defibrillation
EARLY DEFIBBRILLATION — It is most likely to improve
survival by restoring a perfusing rhythm It is the key intervention to
increase the chances of survival of patients with “out-of-hospital” cardiac
arrest.

EARLY ADVANCED LIFE SUPPORT(ALS) — Early life support

provided by paramedics is another critical link in the chain of survival. In
communities with survival rates > 20%, a minimum of two of rescuers should
be trained to the advanced level.
RECOVERY — In October 2020, the American Heart
Association added the recovery phase as the sixth link in the chain
of survival. Recovery consists of cardiac arrest survivors receiving
treatment, surveillance, and rehabilitation at a hospital. It also
includes an assessment for anxiety, depression, and post-traumatic
stress, which can all lead to future repeated events.
2nd

3rd
 EMERGENCY RECOGNITION
Response. Check if the victim is responsive or
unresponsive. As you approach them, introduce yourself
and ask them questions to see if you can get a response.
Kneel next to their chest and gently shake their shoulders,
asking, ‘What has happened?’, ‘Open your eyes!’ “hey,
hey, are you okay?”
• If the victim opens their eyes, or gives another gesture,
they are responsive.
• If they do not respond to you in any way they are
unresponsive and should be treated as quickly as
possible.
 DONE SIMULTANEOUSLY
Breathing. check if the victim is breathing normally. Place
your ear above their mouth, looking down their body. Listen
for sounds of breathing and see if you can feel their breath on
your cheek. See if their chest moves.

Pulse Check. Locate the carotid artery pulse – slide 2 or 3

fingers into the groove between the trachea and the muscles at
the side of the neck
• take at least 5 seconds but no more than 10 seconds to
minimize delay or interruptions.
• If you are alone and victim is unresponsive, shout for
help. If no one responds, activate the EMS (emergency
response system), and get an AED (Automated External
Defibrillator) if available.
• If victim is unresponsive, you do not definitely feel a
pulse, not breathing or breathing abnormally, within
10seconds, perfom 5 cycles of compressions and breaths
30:2ratio, starting with compressions (C-A-B sequence)
COMPRESSIONS
AIRWAY
BREATHING
• When in doubt feeling a pulse; start CPR! - it is better to
start a false code.
 CHEST COMPRESSIONS
• Position yourself at the victim’s side
• Make sure that the victim is lying face up on a
firm surface. If the patient is facedown, carefully
roll him faceup. If head or neck injury is
suspected, do logrolling keeping the head, neck,
and torso in line while repositioning the victim.
• Place the heel of your hand on the breastbone at
the centre of the person's chest. Place your other
hand on top of your first hand and interlock your
fingers.
• Position yourself with your shoulders
above your hands and straighten your
arms.

• Using your body weight (not just your

arms), press straight down by 5 to 6cm
(2 to 2.5 inches) on their chest.
• Keep those arms as straight as possible. Arm
muscles tire a lot more quickly than your
body weight. Keeping the arms straight helps
body weight drive the compression down and
maintain proper depth.

• The rescuer’s hands need to stay in contact

with the patient’s chest during compressions.
Avoid being a bouncer by maintaining hand
contact with the chest wall. Remember to
avoid “leaning” on the victim.
• Do not ‘criss-cross’ your hands. To
maximize the force of compressions, the
rescuer’s hands need to be straight over
each other.

• Repeat these compressions at a rate of at

least 100 to 120 times a minute until an
ambulance arrives or you become
exhausted. Minimize interruptions.
• Keeping your hands on victim’s chest,
release the compression and allow the
chest to return to its original position.
Chest recoil allows blood to flow into
the heart and is necessary for chest
compressions to create blood flow.
Incomplete chest recoil is harmful
because it reduces the blood flow created
by the chest compressions.
Compressions and recoil should be
equal.
Airway. you need to check that the airway is open
and clear. Open the airway by placing one hand on
the forehead to tilt the head back and use two fingers
from the other hand to lift the chin. If head or neck
injury is suspected, perform Jaw-thrust Manuever.

Breathing. check breathing along with pulse check

always; every after 5 cycles of 30 compressions: 2
breaths (2minutes)
• After 30 compressions, open the airway and give
two breaths.
• Keep alternating 30 compressions with two breaths
(30:2) until:
* emergency help arrives and takes over
* the victim starts showing signs of life
* an AED or defibrillator is ready to be used.
 AED – AUTOMATED
EXTERNAL DEFIBRILLATOR
it is a portable medical device designed to analyze the heart rhythm and deliver
an electric shock to a victim experiencing sudden cardiac arrest and expected to
restore the heart rhythm to normal. Ventricular Fibrillation is the uncoordinated
heart rhythm most often responsible for sudden cardiac arrest.
• When the helper returns with a defibrillator, ask for it to
be switched on and to take the pads out, while you
continue CPR. They should remove or cut through
clothing to get to the casualty's bare chest. They also need
to wipe away any sweat. The defibrillator will give you
voice prompts on what to do.
• They should attach the pads to the victims’s chest, by
removing the backing paper.
• The first pad should be on the upper right side below the
collar bone.
• The second pad should be on the victims’s left side below
the arm pit.
• The defibrillator will analyze the heart’s rhythm. Stop
CPR and make sure no one is touching the victim. It
will then give a series of visual and verbal prompts
that should be followed.
• If the defibrillator tells you that a shock is needed, tell
people to stand back. The defibrillator will tell you
when to press the shock button. After the shock has
been given the defibrillator will tell you to continue
CPR for two minutes before it re-analyses.
• If the defibrillator tells you that no shock is needed
continue CPR for two minutes before the defibrillator
re-analyses.
 SPECIAL
CONSIDERATIONS
• VICTIM HAS A HAIRY CHEST – let the pads stick firmly, if the AED prompts
“check pads” or “check electrodes” quickly pull off the pads, this should remove large
amount of chest hair and stick new set of pads to the skin. If a razor is available, shave
the area where you will put your pads.
• WATER – water is a good conductor. Do not use AED in water. Reposition the victim
away from the water and wipe the chest dry before applying the pads.
• IMPLANTED DEFIBRILLATORS & PACEMAKERS – the device may block
the delivery of the shock to the heart. If possible, avoid placing the pads directly on the
implanted device
• TRANSDERMAL PATCHES – Do not place AED pads directly on top of the
medication patch as it may block the transfer of energy and may cause burn to the skin.
 HOW TO DO CPR ON A CHILD
• Child – 1year of age to age of Puberty
• Performed a primary survey similar to the adults
• If you witnessed that the child is unresponsive and not
breathing you should ask help to call for emergency
help while you start CPR. Ask a helper to find and
bring an AED if available. If you are alone, CALL
First! then get back to the child as soon as possible.
• If you did not witness the arrest or you are on your
own, you need to give two minute of CPR before
calling help. CARE First!
• Start CPR. Place them on a firm surface and open their
airway.
• Give five initial rescue breaths.
• Take the hand from the forehead and pinch the soft part of
the nose closed, allowing the mouth to fall open.
• With the head still tilted, take a breath and put your mouth
around the child’s, to make a seal.
• Blow into their mouth gently and steadily for up to one
second, until the chest rises.
• Remove your mouth and watch the chest fall.
• That’s one rescue breath. Do this five times.
• You will then need to give 30 chest compressions.
• Kneel by the child and put one hand in the centre
of the child’s chest.
• May use 1 to 2-handed chest compression
• Push down a third of the depth of the chest,
approximately 5cm (2inches) for children.
• Release the pressure allowing the chest to recoil.
• Repeat this 30 times at a rate of at least 100 to 120
compressions per minute.
• If two rescuers are present, do 15:2 compression-
ventilation ratio
• After 30 compressions, open the airway and give two
breaths.
• It is vital that you perform rescue breaths as cardiac
arrest in a child is likely caused by a respiratory problem.
• Keep alternating 30 compressions with two breaths
(30:2) until:
* emergency help arrives and takes over
* the child starts showing signs of life and starts to
breathe normally
* an AED or defibrillator is ready to be used.
• If the helper returns with a defibrillator, ask them
to switch it on and follow the voice prompts
while you continue with CPR.
• If the child shows signs of becoming responsive
such as coughing, opening eyes, speaking, and
starts to breathe normally, put them in
the recovery position.
• Monitor their level of response and prepare to
give CPR again if necessary.
• If you have used a defibrillator, leave it attached.
 HOW TO DO INFANT CPR
• Infant – 0 to 1year of age (12months) excluding newly
born baby in the delivery room.
• Perform a primary survey, check infant’s pulse in
brachial artery pulse as shown in the picture.
• if you witnessed that the baby is unresponsive and not
breathing, you should ask a helper to call for emergency
help while you start CPR. If you are alone, CALL First!
then get back to the infant as soon as possible.
• If you did not witness the arrest or you are on your own,
you need to give two minute of CPR before calling
help. CARE First!
• Start CPR. Place them on a firm surface and
open their airway. To do this, place one hand
on their forehead and very gently tilt their head
back. With your other hand, use your fingertip
and gently lift the chin.
• Give five initial puffs. Take a breath and put your
mouth around the baby’s mouth and nose to make
a seal, and blow gently and steadily for up to one
second. The chest should rise. Remove your mouth
and watch the chest fall. That’s one rescue breath,
or puff. Do this five times.
• If their chest doesn't rise, check the airway is open.
• It is vital that you perform rescue breaths as
cardiac arrest in a baby is likely caused by a
respiratory problem.
• You will then need to give 30 pumps.
• Put two fingers in the center of the baby’s
chest or two thumb-encircling the baby’s
chest and push down a third of the depth of
the chest, approximately 4cm (1.5inches)
• Release the pressure allowing the chest to
come back up.
• Repeat this 30 times at a rate of at least 100 to
120 pumps per minute.
• If two rescuers are present, do 15:2
compression-ventilation ratio
• After 30 pumps, open the airway and give two puffs.
Keep alternating 30 pumps with two puffs (30:2) until:
*emergency help arrives and takes over
*the baby starts showing signs of life and starts to
breathe normally.

• If the baby shows signs of becoming responsive, such as,

coughing, opening their eyes, making a noise, or starts to
breathe normally, put them in the recovery position.
• Monitor their level of response and prepare to give CPR
again if necessary.
 HOW TO DO CPR IN THIS PANDEMIC:
COVID-19
• If you find someone collapsed, you should first perform
a primary survey.  Do not place your face close to the victim
during the survey.
• If you have established from this that they are unresponsive
and not breathing, you should ask a helper to call for
emergency help while you start CPR. Ask a helper to find and
bring an AED, if available.
• If there is a helper ask him to put the phone on speaker and
hold it out towards you, so they can maintain a 2m distance
• If you are on your own, use the hands-free speaker on a phone
so you can start CPR while speaking to ambulance control.
• Do not leave the victim to look for help or AED. Leaving
the patient and looking for help may spread the virus if the
arrested patient is Covid19 positive.
• Before you start CPR, use a towel or piece of clothing
and lay it over the mouth and nose of the victim.
Victim’s covering must be maintained securely.
• Start Hands only CPR. Do chest compression as
previously stated.

• Do not give rescue breaths.

• Continue to performing Hands only CPR until:  
* emergency help arrives and takes over  
* the person starts showing signs of life and
starts to breathe normally
* you are too exhausted to continue
* an AED is ready to be used.
• If the helper returns with a defibrillator, ask them to switch it on
and follow the voice prompts while you continue with CPR.
• Wherever possible, the helper should keep a distance of 2m.

• If the victim shows signs of life and starts to breathe normally, put
them in the recovery position with facial covering in place.
• Monitor their level of response and prepare to give CPR again if
necessary.
• If you have used a defibrillator, leave it attached.
HIGH QUALITY CPR

Compres the chest hard and fast

Allow complete chest recoil after each compression
Minimize interruptions in compressions (10seconds or less)
Avoid excessive ventilation
Switch compressor about every 2minutes or earlier if
fatigued.
*switch should take 5seconds or less
 RECOVERY POSITION AFTER CPR
• If a person is unconscious but is breathing normally and has no
other life-threatening conditions of suspected facture, victim
should be placed in the recovery position.
• Putting someone in the recovery position will keep their airway
clear and open. It also ensures that any vomit or fluid won't cause
them to choke.
HOW TO PUT A VICTIM IN THE RECOVERY
POSITION
• Kneel by the victim’s and straighten their legs.
• If they are wearing glasses, or have any bulky
items in their pockets, remove them.
• Do not search their pockets for small items.

• Place the arm that is nearest to you at a right angle

to their body, with the elbow bent and their palm
facing upwards.
• Bring their other arm across their chest and place the back
of their hand against the cheek nearest to you, and hold it
there.

• With your other hand, pull victim’s far knee up

so that their foot is flat on the floor.

• Keeping the back of the victim’s hand pressed against their

cheek, pull on the far leg to roll the child towards you on
to their side. You can then adjust the top leg so that it is
bent at a right angle.
• You then need to gently tilt the victim’s head back and lift
their chin to make sure their airway stays open. You can
adjust the hand under their cheek to help keep the airway
open.

• If they remain in the recovery position for 30 minutes, roll

them into the recovery position on the other side. 

• Call for emergency help if it hasn’t already been done.

Monitor their level of response while waiting for help to
arrive.
• If the victim is a child, the procedure of
positioning into a recovery position is
similar to as of an adult.

• If the victim is an infant, cradle the

victim in your arms, with their head
tilted downwards to prevent them from
choking or inhaling vomit.

• Call for emergency help if it hasn’t

already been done and monitor their
level of response until help arrives. 
 WHEN TO STOP
CPR
• Victim shows signs of life and starts to breathe
normally, put them in the recovery position.

• Patient has signs of irreversible death (Rigor

Mortis, Decapitation, Dependent Lividity).

• Responsibility is assumed by a more senior

emergency medical professional – paramedics
arriving on the scene or a physician in the
emergency room.
• No physiological benefit can be expected
because the vital functions have
deteriorated as in septic or cardiogenic
shock.
• Rescuer is unable to continue resuscitation
due to exhaustion, the scene is no longer
safe, or when continued resuscitation may
place other lives at risk.
• Presentation of a valid DNAR order to the
rescuer.