▶How do I recognize cardiac arrest and when do I start CPR?
Cardiac arrest is unresponsiveness plus no normal breathing and no pulse. Tap the patient's shoulder and shout 'Are you okay?' Look for breathing: not a gasp or agonal breathing, but normal chest rise and fall. Check the carotid pulse for 5–10 seconds; untrained lay-rescuers may miss it, so the current recommendation is: if unresponsive and not breathing normally, start CPR. Call 911 (or send someone to call), get an AED, and begin chest compressions immediately. The phrase is 'Phone first' for unresponsive, not breathing; if you're alone, call first then return to start compressions. Do not delay CPR to check a pulse.
▶What is the correct hand placement and compression technique?
Place the heel of one hand on the center of the chest (between the nipples) on the lower half of the breastbone. Place your other hand on top and interlock fingers. Keep arms straight, position your shoulders directly over your hands, and compress hard and fast at a rate of 100–120 compressions per minute to a depth of 2–2.4 inches (5–6 cm) in adults. Push down forcefully, then allow full recoil without removing your hands. Compressions are exhausting; switch with another rescuer every 2 minutes (or sooner if fatigued) to maintain quality. The goal is uninterrupted flow of blood to the brain and heart until help arrives or the patient shows signs of life.
▶What is the difference between compression-only CPR and hands-and-ventilation CPR?
Compression-only CPR (pushing hard and fast without rescue breathing) is recommended for untrained rescuers or those uncomfortable with mouth-to-mouth. It maintains some oxygenation and circulation. Hands-and-ventilation CPR (compressions plus rescue breaths at a ratio of 30:2) is taught to all healthcare workers and trained rescuers. Rescue breaths: open the airway, pinch the nose, seal your mouth over the patient's, and deliver one breath over one second; chest should rise. For an infant, use a pinky-sized airway and do not squeeze the bag so hard. The ratio is 100–120 compressions per minute with 2 ventilations every 30 compressions.
▶When and how do I use an AED?
An AED detects fatal rhythms (ventricular fibrillation, pulseless ventricular tachycardia) and delivers an electric shock to restore normal rhythm. As soon as an AED is available, turn it on, expose the patient's chest, and place the pads on the right upper chest and left lower chest (follow the diagrams on the pad package). Let the AED analyze the rhythm; if it advises a shock, clear the patient (no one touching them) and press the shock button. Resume CPR immediately after the shock for 2 minutes, then let the AED re-analyze. If no shock is advised, continue CPR. An AED works only on certain rhythms; asystole (flatline) does not require shock.
▶How long should I perform CPR before stopping?
Continue CPR until: (1) help arrives and takes over, (2) an automated external device (AED) is available and analyzed, (3) the patient shows signs of life (movement, breathing, cough, attempts to speak), (4) you are too exhausted to continue safely (another rescuer takes over), or (5) a provider tells you to stop. In the field, paramedics or ED providers may stop CPR if the patient has been in arrest >30 minutes with no signs of life and no reversible cause. Lay rescuers should assume someone will arrive and keep going. Recent guidelines allow for 'no flow' time during transport; prolonged CPR in cold-water drowning (hypothermia) can reverse the patient.
▶What are the differences between adult, pediatric, and infant CPR?
Adults: hand placement on center of chest, compression depth 2–2.4 inches, 100–120 compressions/minute, 30:2 ratio. Children (1–8 years): use one or two hands depending on size, compress 2 inches at 100–120/minute; if alone, use 30:2; if two rescuers, 15:2 is acceptable. Infants (under 1 year): use two fingers (index and middle) or thumb-encircling method, compress about 1.5 inches, 100–120/minute. Rescue breaths in infants are smaller (puff of air, not a full breath). The emphasis on pediatric CPR is airway—lack of oxygen is the primary problem in children, so rescue breathing is important.
▶What do I do after successful resuscitation and the patient is breathing?
Once the patient has a pulse and is breathing, place them in the recovery position (lying on their side, head tilted back to keep airway open) so that if they vomit, fluid does not obstruct the airway. Reassess vital signs every few minutes. Keep the patient warm (use blankets) to prevent hypothermia. Do not allow them to sit up or walk if they are still altered. Monitor until advanced life support arrives and takes over. In a hospital, the post-resuscitation team will pursue the cause of arrest (EKG, imaging, labs) and cooling protocols (therapeutic hypothermia) to improve neurological outcomes. Your job is successful CPR; the team's job is ensuring the patient survives with a good brain.