HOW TO PERFORM CPR - RESCUE BREATHING 
HEIMLICH MANEUVER

MAKE SURE THE AREA IS SAFE:  If you see a person who is in trouble, or who is lying motionless on the ground, make sure the area is safe before you approach the person.  There may be exposed electrical wires, poison gases, broken glass, or other unknown dangerous elements.  Look and check the area for safety before you approach the scene of an accident.  Be aware that there have been a few cases where a criminal has feigned injury in order to get the person close to them in order to commit a crime.

TALK TO THE PERSON:  As you approach the person, start talking to them to see if they will respond to your questions.  You might say something like, "Hey....are you OK?"

TAP AND SHOUT:  Tap the person on the shoulder and see if they respond to the stimulus and to your voice as you ask them, "Are you OK?....Are you alright?.....Wake up....Can you open your eyes...."

HELP:  If the ADULT victim does not respond, yell "HELP".  If people come to your assistance, point to the first person and tell them, "You, call 911 and report back to me."  Then point to a second person and say, "You, get the AED and bring it back here."  If no person responds to your yell for HELP, and you are alone, immediately get up and call 911 yourself if the victim is an adult.  Be ready to give location, phone number, and be able to describe the situation.  However, if you witness an adult person going down because of a breathing problem such as a near drowning, or near suffocation, or other respiratory problem then you should initiate a simple physical assessment by checking the A B C's ( airway, breathing, circulation ).  Then based upon your physical assessment start CPR or rescue breathing IMMEDIATELY for about ONE full minute.  After giving one minute of CPR or rescue breathing then get up and call 911.  if you are alone when dealing with children and infants you always give one full minute of CPR or rescue breathing before calling 911, because frequently their problem is a respiratory problem and if you give that one full minute of rescue breathing or CPR FIRST then statistically they have a better survival rate.  However, if you find an unconscious adult victim who you did not witness going down, call 911 first before starting your ABC's and CPR.  The reason you call 911 first for an unwitnessed unconscious adult is because their problem is usually cardiac in nature and the faster the EMT arrives and uses the AED then the better chance the adult has in surviving.

A B C PHYSICAL ASSESSMENT:  At this point, you need to check the airway, check for breathing, and check for a pulse before you start CPR or start rescue breathing.  A simple way to memorize this physical assessment is the FOUR COUNT METHOD.  Put your finger on your nose and say out loud, "ONE".  Next, put your finger on your mouth and say, "TWO".  Next, put your finger on your throat and say, "THREE".  Finally, put  your index and middle finger on your carotid artery neck pulse and say, "FOUR".  Do these hand motions while counting out loud.  Do this exercise for about ten repetitions.  After doing ten repetitions of this memory exercise, you will have an excellent understanding of the sequencing steps in doing the ABC physical assessment.  So, you start with the (1) nose, then drop down to the (2) mouth, then drop down to the (3) throat, and then finally drop down to the (4) pulse.  The motion is downward.  Start with the nose and work your way down to the pulse.  #1 - the NOSE is where you check for breathing.  Do a head tilt chin lift to open the airway and then place your ear over the victim's nose and turn your head so that you can view the victim's chest.  Check for breathing.  Can you feel the air coming out of the victim's nose?  Can you hear the air coming out of the victim's nose?  Can you see the victim's chest rise and fall with breathing?  #2 - the MOUTH is where you check the upper airway for obstruction.  Do a tongue jaw lift and look into the victim's mouth and check the mouth for obstruction.  If  you see an obstruction or a foreign body in the mouth, then follow up with a finger sweep.  You cannot do effective rescue breathing or ventilations during CPR if there is food in the mouth or some other type of foreign object in the mouth. #3 - check the TRACHEA ( airway ) for obstruction.  Give two slow ventilations to check to see if the chest rises.  Do not over inflate the victim's lungs.  Breathe in only enough air to make the victim's chest rise UP just a little bit.  Breathe for the victim the way you normally breathe for yourself in the resting state.  If you breathe in too much air into the victim's lungs, the excess air will enter the victim's stomach and this will cause gastric distention which can lead to vomiting.  If the victim vomits they could easily aspirate their vomit into their airway which could be deadly.  Pinch the victim's nose, place your mouth over the mouth of the victim and give mouth to mouth respirations to check for an open airway in the trachea.  If the chest rises with 2 ventilations then you have an open airway.  If the chest does not rise up with two ventilations and the air will not move, then there is a blocked airway.  You will have to clear the airway by using the THREE STEP FLOOR ABDOMINAL THRUST TECHNIQUE.  #4 - Check for a PULSE on the victim's carotid artery.  Check the pulse nearest you with your palm down.  If there is not pulse, start CPR.  If there is a pulse but no breathing or difficult breathing begin rescue breathing.

Perform CPR or rescue breathing for about one full minute and then stop and re-assess for pulse and breathing.  You always stop every minute or so during CPR and check for pulse and breathing.  This is called a PULSE CHECK.

PICTURES OF THE IMPLEMENTATION OF CPR

1.  MAKE SURE THE AREA IS SAFE BEFORE YOU APPROACH THE VICTIM:

2.  TAP AND SHOUT:  "Are you OK?"  "Are you alright?"  "Can you talk?"
Study the picture below.

3.  If there is no response.  Yell "HELP".  Tell the people
who arrive to assist you to call 911 and to get the AED.
The AED is an abbreviation for:  Automated External Debrillator.
Check the picture below.

4.  Check for breathing.  Do a head tilt chin lift and then
Look, listen, and feel for signs of breathing in the victim. 
Check the picture below.

5.  Look in the mouth for food or foreign objects.  Do a tongue
jaw lift and look in the mouth.  If you see food or a foreign
object follow up with a finger sweep.  Be careful.   Never
do a blind finger sweep.  You should be able to see an
object in the mouth before you perform a finger sweep.
Study the picture below.

6.  If you see a foreign object in the victim's mouth, follow up with a
finger sweep.  Be careful.  Never stick your index finger down the
middle of the mouth, because you might push the object deeper into
the airway.  Slowly, and gently enter your finger at the corner of the mouth.
Hook your finger around the foreign object and sweep it out.  Do
a sweeping motion with your finger going from corner to corner of the
victim's mouth.  It takes two hands to properly do a finger sweep.
One hand opens the mouth with a tongue jaw lift.  The other hand
does the finger sweep.  If you try to do a finger sweep with only ONE
hand, the chances are you are going to accidentally push the food
down deeper.  Use TWO hands.  One hand open's the mouth.
The other hand does the finger sweep.  Study the picture below.

7.  Check for an open airway ( trachea ).  FIRST, do a head tilt chin lift.
A head tilt chin lift helps to open the airway and it helps to prevent
the tongue from falling backwards which could block the airway.
Do the head tilt chin lift twice.  The old method was a head tilt
neck lift.  Never do a neck lift because it could cause spinal cord
injury at the cervical spinal cord level.

8.  Give two slow gentle breaths to check to see if the chest
rises.  Pinch the victim's nose shut.  Place your mouth over
the mouth of the victim.  Create a good tight air seal with your
mouth over the mouth of the victim and give two slow, gentle
breaths.  Breathe in only enough air to make the victim's chest
to rise up a little bit.  If the chest rises the airway is open.  If the chest does
not rise then repeat the process again by doing two more head tilt chin
lifts and giving two more slow, gentle ventilations.  If the airway
remains blocked then begin clearing the airway by performing
the 3 step floor ABDOMINAL THRUST maneuver.  Study the picture below.

9.  Once you establish the fact that you have an open airway then check for signs
of circulation:  pulse, movement, coughing, breathing.  Start with the
carotid artery located nearest you.  Place your index and
middle finger along side the neck of the victim and feel for
a carotid pulse.  If no pulse start CPR.  If there is a pulse, but
no signs of breathing or difficulty in breathing then start
rescue breathing.  Study the picture below.

10.  Before you begin adult CPR, locate the XIPHOID PROCESS
at the base of the victim's sternum.  You will have to expose
the victim's chest by removing clothing.  You will also need
a bare chest for skin contact when you implement the AED
which will be discussed later.  To locate the xiphoid process,
place two fingers at the base of the rib cage that is nearest
you and let your fingers follow the outline of the base of
the rib cage.  Your fingers will come into contact with the xiphoid
process.  Study the picture below.

11.  Keep two fingers on the xiphoid process and then at this time your hand
that is doing a head tilt on the victim's forehead can move to the center of the
chest.  This is your bottom compression hand.  Study the picture below.

12.  The reason that you need to locate the xiphoid process on the victim is because
if you do not know where it is located on the victim you might accidentally
put your compression hand over the xiphoid process, and then when you
do perform chest compressions, you might break it off.  If you snap off the
xiphoid process it could puncture the lungs creating a pneumothorax which
could be fatal under such circumstances.  Your compression hand should
be located at the center of the chest, NOT at the lower end of the chest where
the xiphoid process is located.  Study the picture below.

13.  Perform 30 chest compressions at a rate of 100 compressions per minute.  Your
shoulders should be located over the victim's chest.  Your arms should be straight.
Use your body weight to perform chest compressions.  Do not use your arm muscles
to perform chest compressions, but use your body weight, otherwise your chest compressions
will be ineffective and you will become exhausted quickly.  Do not bounce your hands up
and down on the victim's chest.  Keep constant contact between the heel of your compression
hand and the skin of the victim's chest.  Do not rock back and forth as you do chest
compressions.  Your chest compressions should be straight up and down.  The depth of
chest compressions on the adult victim is from 1 1/2 inches to 2 inches deep.  The AGE definition of
ADULT CPR is anyone who looks like they are over the age of 8 years.  It is a judgment
call that you have to make.  If the person looks like they are over the age of 8 ( nine years
old and older) then they will receive two handed adult CPR.  When you perform two handed
adult CPR, interlace your fingers, lift up the bottom fingers so that you are using the HEEL
of your bottom hand to perform chest compressions.  NEVER use the PALM of your hand,
use the HEEL of your hand.  Study the picture below.

Watch This YouTube Video On The Basics of Adult CPR

Watch This YouTube Video On Adult Rescue Breathing