Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many

emergencies, including heart attack or near drowning, in which someone's breathing or

heartbeat has stopped. In 2010, the American Heart Association updated its guidelines to
recommend that everyone — untrained bystanders and medical personnel alike — begin
CPR with chest compressions.

It's far better to do something than to do nothing at all if you're fearful that your
knowledge or abilities aren't 100 percent complete. Remember, the difference between
your doing something and doing nothing could be someone's life.

Here's advice from the American Heart Association:

• Untrained. If you're not trained in CPR, then provide hands-only CPR. That
means uninterrupted chest compressions of about 100 a minute until paramedics
arrive (described in more detail below). You don't need to try rescue breathing.
• Trained, and ready to go. If you're well trained and confident in your ability,
begin with chest compressions instead of first checking the airway and doing
rescue breathing. Start CPR with 30 chest compressions before checking the
airway and giving rescue breaths.
• Trained, but rusty. If you've previously received CPR training but you're not
confident in your abilities, then just do chest compressions at a rate of about 100 a
minute. (Details described below.)

The above advice applies to adults, children and infants needing CPR, but not newborns.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more
definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the absence of oxygenated blood can cause irreparable brain
damage in only a few minutes. A person may die within eight to 10 minutes.

To learn CPR properly, take an accredited first-aid training course, including CPR and
how to use an automatic external defibrillator (AED).

Before you begin

Before starting CPR, check:

• Is the person conscious or unconscious?

• If the person appears unconscious, tap or shake his or her shoulder and ask loudly,
"Are you OK?"
• If the person doesn't respond and two people are available, one should call 911 or
the local emergency number and one should begin CPR. If you are alone and have
immediate access to a telephone, call 911 before beginning CPR — unless you
think the person has become unresponsive because of suffocation (such as from
drowning). In this special case, begin CPR for one minute and then call 911 or the
local emergency number.
 • If an AED is immediately available, deliver one shock if instructed by the device,
then begin CPR.

Remember to spell C-A-B

In 2010, the American Heart Association changed its long-held acronym of ABC to CAB
— circulation, airway, breathing — to help people remember the order to perform the
steps of CPR. This change emphasizes the importance of chest compressions to help keep
blood flowing through the heart and to the brain.

Circulation: Restore blood circulation with chest compressions

1. Put the person on his or her back on a firm surface.

2. Kneel next to the person's neck and shoulders.
3. Place the heel of one hand over the center of the person's chest, between the
nipples. Place your other hand on top of the first hand. Keep your elbows straight
and position your shoulders directly above your hands.
4. Use your upper body weight (not just your arms) as you push straight down on
(compress) the chest at least 2 inches (approximately 5 centimeters). Push hard at
a rate of about 100 compressions a minute.
5. If you haven't been trained in CPR, continue chest compressions until there are
signs of movement or until emergency medical personnel take over. If you have
been trained in CPR, go on to checking the airway and rescue breathing.

Airway: Clear the airway

1. If you're trained in CPR and you've performed 30 chest compressions, open the
person's airway using the head-tilt, chin-lift maneuver. Put your palm on the
person's forehead and gently tilt the head back. Then with the other hand, gently
lift the chin forward to open the airway.
2. Check for normal breathing, taking no more than five or 10 seconds. Look for
chest motion, listen for normal breath sounds, and feel for the person's breath on
your cheek and ear. Gasping is not considered to be normal breathing. If the
person isn't breathing normally and you are trained in CPR, begin mouth-to-
mouth breathing. If you believe the person is unconscious from a heart attack and
you haven't been trained in emergency procedures, skip mouth-to-mouth rescue
breathing and continue chest compressions.

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the
mouth is seriously injured or can't be opened.

1. With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils
shut for mouth-to-mouth breathing and cover the person's mouth with yours,
making a seal.
 2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one
second — and watch to see if the chest rises. If it does rise, give the second
breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then
give the second breath. Thirty chest compressions followed by two rescue breaths
is considered one cycle.
3. Resume chest compressions to restore circulation.
4. If the person has not begun moving after five cycles (about two minutes) and an
automatic external defibrillator (AED) is available, apply it and follow the
prompts. Administer one shock, then resume CPR — starting with chest
compressions — for two more minutes before administering a second shock. If
you're not trained to use an AED, a 911 operator may be able to guide you in its
use. Use pediatric pads, if available, for children ages 1 through 8. Do not use an
AED for babies younger than age 1. If an AED isn't available, go to step 5 below.
5. Continue CPR until there are signs of movement or emergency medical personnel
take over.

To perform CPR on a child

The procedure for giving CPR to a child age 1 through 8 is essentially the same as that
for an adult. The differences are as follows:

• If you're alone, perform five cycles of compressions and breaths on the child —
this should take about two minutes — before calling 911 or your local emergency
number or using an AED.
• Use only one hand to perform heart compressions.
• Breathe more gently.
• Use the same compression-breath rate as is used for adults: 30 compressions
followed by two breaths. This is one cycle. Following the two breaths,
immediately begin the next cycle of compressions and breaths.
• After five cycles (about two minutes) of CPR, if there is no response and an AED
is available, apply it and follow the prompts. Use pediatric pads if available. If
pediatric pads aren't available, use adult pads.

Continue until the child moves or help arrives.

To perform CPR on a baby

Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or
choking. If you know the baby has an airway obstruction, perform first aid for choking. If
you don't know why the baby isn't breathing, perform CPR.

To begin, examine the situation. Stroke the baby and watch for a response, such as
movement, but don't shake the baby.
If there's no response, follow the CAB procedures below and time the call for help as
follows:

• If you're the only rescuer and CPR is needed, do CPR for two minutes — about
five cycles — before calling 911 or your local emergency number.
• If another person is available, have that person call for help immediately while
you attend to the baby.

Circulation: Restore blood circulation

1. Place the baby on his or her back on a firm, flat surface, such as a table. The floor
or ground also will do.
2. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of
one hand just below this line, in the center of the chest.
3. Gently compress the chest about 1.5 inches (about 4 cm).
4. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of
100 compressions a minute.

Airway: Clear the airway

1. After 30 compressions, gently tip the head back by lifting the chin with one hand
and pushing down on the forehead with the other hand.
2. In no more than 10 seconds, put your ear near the baby's mouth and check for
breathing: Look for chest motion, listen for breath sounds, and feel for breath on
your cheek and ear.

Breathing: Breathe for the infant

1. Cover the baby's mouth and nose with your mouth.

2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver
gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into
the baby's mouth one time, taking one second for the breath. Watch to see if the
baby's chest rises. If it does, give a second rescue breath. If the chest does not rise,
repeat the head-tilt, chin-lift maneuver and then give the second breath.
3. If the baby's chest still doesn't rise, examine the mouth to make sure no foreign
material is inside. If the object is seen, sweep it out with your finger. If the airway
seems blocked, perform first aid for a choking baby.
4. Give two breaths after every 30 chest compressions.
5. Perform CPR for about two minutes before calling for help unless someone else
can make the call while you attend to the baby.
6. Continue CPR until you see signs of life or until medical personnel arrive.
Cardiopulmonary Resuscitation (CPR)
When you perform cardiopulmonary resuscitation (CPR), you are using mouth-to-
mouth resuscitation to help the person breathe and chest compressions to help
the person’s heart pump blood.

The brief review of CPR on the following pages can help you in an emergency;
however, this information should not take the place of a certified course in CPR.

Immediate care
Assess the situation. Call out for someone to get help or call 911 yourself if the
person does not seem to need immediate assistance. You can determine this by
gently shaking the person and asking in a loud voice “Are you OK?” If there is no
response, begin CPR and continue until help arrives.

CPR on an Infant
Basic CPR on an infant is five chest compressions and one breath.

1. To find a pulse, locate 2. If the baby is not 3. If the baby has

the brachial artery in the breathing, tilt the head no pulse, use two
upper arm. It is located on back slightly to open the fingers to perform
the underside of the arm airway. Put a washcloth or chest
between muscle and thin pad of clothing under compressions.
bone. Use two fingers to the baby’s shoulders. This Place your fingers
feel for the pulse. keeps the head from one finger width
assuming its naturally below an
forward position. Form a imaginary line
seal with your mouth over connecting the
the baby’s mouth and infant’s nipples.
nose. Blow one breath (a Push down 1 inch
smaller breath than you with each
would give to an adult), so compression.
that the baby’s chest rises. Count out loud: “1
 and 2 and 3 and 4
and 5.” You may
have to repeat the
five compressions
and one breath
multiple times.
You will push
down on the chest
120 times per
minute. Continue,
alternating five
compressions and
one breath, until
help arrives.

CPR on a Child Under Age 8

Basic CPR on a child is five chest compressions and one breath. You may have
to repeat the five compressions and one breath multiple times. You will push
down on the chest 100 to 120 times per minute. Continue until breathing begins
or help arrives.

• Kneel next to the child.

• With the fingers of the hand that is closest to the

child’s feet, find the bottom of the breastbone.

• Place the heel of one hand below the nipples and

above the bottom of the breastbone and push down
forcefully, 1 1/2 inches with each compression; then
let the chest rise. Count out loud: “1 and 2 and 3 and 4 and 5.”

• Then tilt the child’s head back slightly and form a seal with your
mouth over the child’s mouth and nose (see Mouth-to-Mouth-and-
Nose Resuscitation on a Child Under Age 8 or on an Infant, p. 1197).
Blow one breath so that the chest rises.

• Continue, alternating five compressions and one breath, until help

arrives.
CPR on a Child 8 Years or Older or on an Adult

1. Lay the person on a 2. Tilt the head back slightly 3. Look for the
hard, flat surface. Look into to open the airway. Put person’s chest to
the mouth and throat to upward pressure on the jaw rise and fall.
ensure that the airway is to pull it forward. Listen for the
clear. If an object is sounds of
present, try to sweep it out breathing. Feel
with your fingers. Use for the person’s
disposable surgical gloves breath on your
if they are available. If cheek.
vomiting occurs, turn the
person on his or her side
and sweep out the mouth
with two fingers. Do not
place fingers in the mouth if
there is rigidity or if the
person is having a seizure.
Treating Different Types of Burns

By: Rachel Mork

There are several different types of burns, and treatment for each type of burn varies
significantly. It is crucial, then, that you don't make the mistake of treating all burns the
same way. Take the time to determine the type of burn with which you are dealing so you
can get the right medical treatment as soon as possible. Burns in general are very serious
injuries; you don't want to delay treatment any longer than necessary.

Chemical Burns
Chemical burns are caused not by a heat or electric source, but by a chemical substance.
Most chemical burns come from acidic substances - cleansers, dyes or chemicals. A
chemical burn can be more serious than a heat burn if it covers a large area of your body
or burns your eyes, face or groin.

If you have a chemical burn, immediately flush the burned area with cool, clean water.
Flush the burn for at least 15 minutes. Seek medical attention if the burn does not subside
within a half hour or the burn affects your eyes, face or groin. Watch for signs of shock.

Electrical Burns
Electrical burns can be incredibly deceiving because they often do not show a serious
external burn. The electrical current, however, can cause significant - even life-
threatening - internal damage as it passes through your body.

If you suspect a person has an electrical burn, you will need to carefully disconnect them
from the source of the electrical current, cover them to prevent shock and call 911 to get
immediate medical attention.

Heat Burns
Burns from fire, hot items, hot water or the sun can also be serious and even life-
threatening. When treating a heat burn, you will want to determine how serious the burn
is before deciding what method of treatment to use.

First and second degree burns of three inches in diameter and smaller can be treated by
cooling the burn through submerging the burn in cold water for fifteen minutes. Cover
the burn with a clean bandage and take an over-the-counter pain killer such as
acetaminophen. Third degree burns and second degree burns that are larger than three
inches in diameter require immediate medical attention. Cover the victim's burns with
clean, moist bandages or sheets, keep the victim warm to prevent shock and call 911
immediately.

How to Treat a Chemical Burn

By: Rachel Mork

It's advisable to learn how to treat a chemical burn before you are actually in the position
of dealing with the situation, since a chemical burn responds best to immediate treatment.
Every second the chemical is left on the burn is one more second the burn can progress.

As soon as you realize you've got a chemical burn, you need to treat the burn injury.
Follow these simple steps as soon as possible:

Flush the Burn

Immediately flush the burn with cool water. Flush for at least 15 minutes, being as
thorough and careful as possible. The burned skin is already traumatized, so try not to rub
or scrub the area; instead, flush the area without disturbing the skin more than necessary.
Repeatedly pour or scoop clean, fresh water into or over the burned area.
If the burn is not subsiding, have someone call 911 as you flush the burned area. If the
burn is in your eye, call 911 while flushing the eye. A chemical burn to the eye can be
very serious, requiring immediate medical attention.

Cover the Burn

Use a clean bandage or clean sheets to cover the burned area. If the burned area is large-
over three inches in diameter-seek medical attention immediately, keeping the burned
area sterile and protecting it by keeping it covered.

Keep Warm
Your body may go into shock if the burn was intense of affected a large area of your
body. Wrap your self in a sheet or large thin blanket to avoid going into shock.

Be Watchful
Small chemical burns can heal without further medical treatment, but serious chemical
burns require immediate medical attention, especially if you feel faint, are pale or are
having trouble breathing or speaking. Watch for signs that the burn is affecting you. Ask
a friend to drive you to the hospital or call 911 if the burn is serious, affects your sight or
is making you feel faint and weak.

Burns: First aid

To distinguish a minor burn from a serious burn, the first step is to determine the extent
of damage to body tissues. The three burn classifications of first-degree burn, second-
degree burn and third-degree burn will help you determine emergency care:

First-degree burn
The least serious burns are those in which only the outer layer of skin is burned, but not
all the way through. The skin is usually red, with swelling, and pain sometimes is present.
Treat a first-degree burn as a minor burn unless it involves substantial portions of the
hands, feet, face, groin or buttocks, or a major joint, which requires emergency medical
attention.

Second-degree burn
When the first layer of skin has been burned through and the second layer of skin
(dermis) also is burned, the injury is called a second-degree burn. Blisters develop and
the skin takes on an intensely reddened, splotchy appearance. Second-degree burns
produce severe pain and swelling.

If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat it
as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin
or buttocks, or over a major joint, treat it as a major burn and get medical help
immediately.

For minor burns, including first-degree burns and second-degree burns limited to an
area no larger than 3 inches (7.6 centimeters) in diameter, take the following action:

• Cool the burn. Hold the burned area under cool (not cold) running water for 10
or 15 minutes or until the pain subsides. If this is impractical, immerse the burn in
cool water or cool it with cold compresses. Cooling the burn reduces swelling by
conducting heat away from the skin. Don't put ice on the burn.
• Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other
material that may get lint in the wound. Wrap the gauze loosely to avoid putting
pressure on burned skin. Bandaging keeps air off the burn, reduces pain and
protects blistered skin.
• Take an over-the-counter pain reliever. These include aspirin, ibuprofen
(Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others).
Use caution when giving aspirin to children or teenagers. Though aspirin is
approved for use in children older than age 2, children and teenagers recovering
from chickenpox or flu-like symptoms should never take aspirin. Talk to your
doctor if you have concerns.

Minor burns usually heal without further treatment. They may heal with pigment
changes, meaning the healed area may be a different color from the surrounding skin.
Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If
infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less
than a year old — doing so may cause more extensive pigmentation changes. Use
sunscreen on the area for at least a year.

Caution

• Don't use ice. Putting ice directly on a burn can cause a burn victim's body to
become too cold and cause further damage to the wound.
• Don't apply butter or ointments to the burn. This could cause infection.
• Don't break blisters. Broken blisters are more vulnerable to infection.

Third-degree burn
The most serious burns involve all layers of the skin and cause permanent tissue damage.
Fat, muscle and even bone may be affected. Areas may be charred black or appear dry
and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic
effects may occur if smoke inhalation accompanies the burn.

For major burns, call 911 or emergency medical help. Until an emergency unit arrives,
follow these steps:

1. Don't remove burned clothing. However, do make sure the victim is no longer
in contact with smoldering materials or exposed to smoke or heat.
 2. Don't immerse large severe burns in cold water. Doing so could cause a drop
in body temperature (hypothermia) and deterioration of blood pressure and
circulation (shock).
3. Check for signs of circulation (breathing, coughing or movement). If there is
no breathing or other sign of circulation, begin CPR.
4. Elevate the burned body part or parts. Raise above heart level, when possible.
5. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist
cloth; or moist towels.

Get a tetanus shot. Burns are susceptible to tetanus. Doctors recommend you get a
tetanus shot every 10 years. If your last shot was more than five years ago, your doctor
may recommend a tetanus shot booster.