First Responder EMS Curriculum for Training Centers in Eurasia

Step 5:Step 6:Step 7:Step 8:Step 9:Step 10:Step 11:If the patient is breathing, and no trauma is suspected, place the patient inthe recovery position. If the patient is not breathing, give two rescue breaths(mouth-to-mouth, mouth-to-barrier device, mouth-to-mask, or bag-valvemask ventilations). Ventilate the patient at approximately every 5 secondsto achieve a rate of 12 breaths/minute. Each breath should take about 2seconds, causing the chest to rise with effective ventilations. A secondrescuer applying cricoid pressure may effectively compress the esophagusand limit the amount of gastric distension and possible vomiting. Thecricoid ring lies just below the Adam’s apple (larynx) and is compressedusing the thumb and index finger.Circulation – After you open the airway and assess the breathing, assess thepatient’s circulation by checking the carotid pulse for 5 to 10 seconds. If thepatient has a pulse, but is not breathing, perform rescue breaths every 5seconds (12 breaths/minute). Reassess the patient’s breathing andcirculation every few minutes.If the patient does not have a pulse, find the appropriate hand position andbegin chest compressions. A patient without a pulse is in cardiac arrest.Perform 15 chest compressions at a rate of 80 to –100/minute. Open theairway and deliver two rescue breaths. Then perform 15 more chestcompressions. Then give two more rescue breaths, and so on.Perform four cycles of 15 compressions to 2 ventilations.After four cycles, reassess the pulse for 3 to 5 seconds. If the patient has apulse, reassess breathing. If breathing is present, keep reassessing the patientand place him/her in the recovery position (lying the non-traumatic patient onhis/her side to maintain an open airway). If breathing is absent, continue rescuebreathing every 5 seconds (12 breaths/minute). If the patient does not have apulse, continue chest compressions.Continue to reassess the patient’s airway, breathing, and circulation everyfew minutes.Chest Compressions – Always remember that the patient should be supineon a firm, flat surface for effective compressions. Hand position for chestcompressions varies with age. On the adult patient, the rescuer shouldlocate the edge of the ribs on the side of the patient nearest to them. Tracethe rib to the midline positioned sternum and xiphoid process. Place twofingers over the xiphoid process, and then the heel of the other hand justabove these fingers on the lower half of the sternum. The heel of the secondhand is then placed over the first hand. Lean over the patient so that yourshoulders are directly over the sternum. This allows the rescuer to applydirect downward pressure most effectively. Remember, chest compressionsover the xiphoid process could break this bone and damage internal organs.Compressions should depress the sternum of the adult patientapproximately 2 inches. Release pressure in between compressions to allowrefilling of the heart with blood. Compression and relaxation times shouldbe equal. Hands should remain on the chest at all times to maintainappropriate hand position. If hand position is lost, or after reassessing theABCs, hand position should be resumed as above. The rate of compressionsin the adult should be between 80 and –100/minute.b. Steps of Two-Rescuer CPRAdult CPR can be performed with one or two rescuers. Two-rescuer CPR is moreefficient and less tiring. In two-rescuer CPR, one rescuer performs chest compressions,while the other rescuer provides rescue breathing and pulse assessment. If a pulse can befelt during compressions, then they are effective compressions. If the rescuer doing thecompressions becomes fatigued, the rescuers may switch positions.First Responder EMS Curriculum/AIHA, July 2002 107