CPR - adult and child after onset of puberty
CPR stands for cardiopulmonary resuscitation. It is a lifesaving procedure that is done when someone's breathing or heartbeat has stopped. This may happen after an electric shock, drowning, or heart attack. CPR involves:
Permanent brain damage or death can occur within minutes if a person's blood flow stops. Therefore, you must continue CPR until the person's heartbeat and breathing return, or trained medical help arrives.
For the purposes of CPR, puberty is defined as breast development in females and the presence of axillary (armpit) hair in males.
Cardiopulmonary resuscitation - adult; Rescue breathing and chest compressions - adult; Resuscitation - cardiopulmonary - adult; Cardiopulmonary resuscitation - child 9 years and older; Rescue breathing and chest compressions - child 9 years and older; Resuscitation - cardiopulmonary - child 9 years and older
CPR is best done by someone trained in an accredited CPR course. The procedures described here are NOT a substitute for CPR training. The newest techniques emphasize compression over rescue breathing and airway management, reversing a long-standing practice. See www.heart.org/HEARTORG/ for classes near you.
Time is very important when an unconscious person is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.
Machines called automated external defibrillators (AEDs) can be found in many public places, and are available for home use. These machines have pads or paddles to place on the chest during a life-threatening emergency. They automatically check the heart rhythm and give a sudden shock if, and only if, that shock is needed to get the heart back into the right rhythm. When using an AED, follow the instructions exactly.
In adults, major reasons that heartbeat and breathing stop include:
CPR should be done if a person has any of the following symptoms:
1. Check for responsiveness. Shake or tap the person gently. See if the person moves or makes a noise. Shout, "Are you OK?"
2. Call 911 if there is no response. Shout for help and send someone to call 911. If you are alone, call 911 and retrieve an AED (if available), even if you have to leave the person.
3. Carefully place the person on their back. If there is a chance the person has a spinal injury, two people should move the person to prevent the head and neck from twisting.
4. Perform chest compressions:
5. Open the airway. Lift up the chin with 2 fingers. At the same time, tilt the head by pushing down on the forehead with the other hand.
6. Look, listen, and feel for breathing. Place your ear close to the person's mouth and nose. Watch for chest movement. Feel for breath on your cheek.
7. If the person is not breathing or has trouble breathing:
8. Repeat chest compressions and rescue breathing until the person recovers or help arrives. If an AED for adults is available, use it as soon as possible.
If the person starts breathing again, place them in the recovery position. Keep checking for breathing until help arrives.
When to Contact a Medical Professional
In adults, to avoid injuries and heart problems that can lead to the heart stopping beating:
American Heart Association. Highlights of the 2015 American Heart Association guidelines update for CPR and ECC. eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf. Accessed March 14, 2019.
Duff JP, Topjian A, Berg MD, et al. 2018 American Heart Association focused update on pediatric advanced life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;138(23):e731-e739. PMID: 30571264 www.ncbi.nlm.nih.gov/pubmed/30571264.
Morley PT. Cardiopulmonary resuscitation (including defibrillation). In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 21.
Panchal AR, Berg KM, Kudenchuk PJ, et al. 2018 American Heart Association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;138(23):e740-e749. PMID: 30571262 www.ncbi.nlm.nih.gov/pubmed/30571262.
Review Date: 1/12/2019
Reviewed By: Jesse Borke, MD, FACEP, FAAEM, Attending Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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