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Plethysmograph
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Plethysmograph

MeSH
MedlinePlus

Diagnostics
D010991
003771

Plethysmograph or "body box" used in lung measurements

A man undergoing whole body plethysmography

A modern body plethysmograph using ultrasound
A plethysmograph is an instrument for measuring changes in volume within
an organ or whole body (usually resulting from fluctuations in the amount of blood or air
it contains).

Contents
[hide]
1 Organs studied
o 1.1 Lungs
o 1.2 Limbs
o 1.3 Genitals
2 Use in preclinical research
o 2.1 Respiratory parameters from conscious freely moving animals: wholebody plethysmography
o 2.2 Respiratory parameters from conscious restrained animals: doublechamber / head-out plethysmography
o 2.3 Resistance/compliance from sedated animals
o 2.4 Cerebral blood flow
3 See also
4 References

5 Further reading
6 External links

Organs studied[edit]
Lungs[edit]
Pulmonary plethysmographs are commonly used to measure the functional residual
capacity (FRC) of the lungs—the volume in the lungs when the muscles of respiration
are relaxed—and total lung capacity.
In a traditional plethysmograph, the test subject is placed inside a sealed chamber the
size of a small telephone booth with a single mouthpiece. At the end of normal
expiration, the mouthpiece is closed. The patient is then asked to make an inspiratory
effort. As the patient tries to inhale (a maneuver which looks and feels like panting), the
lungs expand, decreasing pressure within the lungs and increasing lung volume. This, in
turn, increases the pressure within the box since it is a closed system and the volume of
the box compartment has decreased to accommodate the new volume of the subject.
Boyle's Law is used to calculate the unknown volume within the lungs. First, the change
in volume of the chest is computed. The initial pressure and volume of the box are set
equal to the known pressure after expansion times the unknown new volume. Once the
new volume is found, the original volume minus the new volume is the change in
volume in the box and also the change in volume in the chest. With this information,
Boyle's Law is used again to determine the original volume of gas in the chest: the initial
volume (unknown) times the initial pressure is equal to the final volume times the final
pressure.
The difference between full and empty lungs can be used to assess diseases and
airway passage restrictions. An obstructive disease will show increased FRC because
some airways do not empty normally, while a restrictive disease will show decreased
FRC. Body plethysmography is particularly appropriate for patients who have air spaces
which do not communicate with the bronchial tree; in such patients helium dilution would
give an incorrectly low reading.
Another important parameter, which can be calculated with a body plethysmograph is
the airway resistance. During inhalation the chest expands, which increases the
pressure within the box. While oberserving the so-called resistance loop (cabin pressure
and flow), diseases can easily be recognized. If the resistance loop becomes planar,
this shows a bad compliance of the lung. A COPD, for instance, can easily be
discovered because of the unique shape of the corresponding resistance loop.

Limbs[edit]
Some plethysmograph devices are attached to arms, legs or other extremities and used
to determine circulatory capacity. In water plethysmography an extremity, e.g. an arm, is

enclosed in a water-filled chamber where volume changes can be detected. Air
plethysmography uses a similar principle but based on an air-filled long cuff, which is
more convenient but less accurate. Another practical device is mercury-filled strain
gauges used to continuously measure circumference of the extremity, e.g. at mid
calf. Impedance plethysmography is a non-invasive method used to detect venous
thrombosis in these areas of the body.

Genitals[edit]
Another common type of plethysmograph is the penile plethysmograph. This device is
used to measure changes in blood flow in the penis. Although some researchers use
this device to assess sexual arousal and sexual orientation, the data are usually not
admissible in court cases in the United States. An approximate female equivalent to
penile plethysmography is vaginal photoplethysmography, which optically measures
blood flow in the vagina.[1]

Use in preclinical research[edit]
Plethysmography is a widely used method in basic and preclinical research to study
respiration. Several techniques are used:

Respiratory parameters from conscious freely moving animals: wholebody plethysmography[edit]
Whole-body plethysmography is used to measure respiratory parameters in conscious
unrestrained subjects, including quantification ofbronchoconstriction.
The standard plethysmograph sizes are for the study of mice, rats and guinea pigs. On
request, larger plethysmographs can also be manufactured for other animals, such as
rabbits, dogs, pigs, or primates.
The plethysmograph has two chambers, each fitted with a pneumotachograph. The
subject is placed in one of them (subject chamber) and the other remains empty
(reference chamber).
The pressure change is measured by a differential pressure transducer with one port
exposed to the subject chamber and the other to the reference chamber.

Respiratory parameters from conscious restrained animals: doublechamber / head-out plethysmography[edit]
The double-chamber plethysmograph (dcp) measures respiratory parameters in a
conscious restrained subject, including airway resistance and conductance. Different
sizes of plethysmograph exist to study mice, rats or guinea pigs.

The head-out configuration is identical to the standard configuration described above
except that there is no head chamber.
Of course the collar seal is still applied, so that the body chamber remains airtight. With
only a thoracic signal, all parameters can be obtained except for specific airway
resistance (SRaw) and specific airway conductance (Sgaw).

Resistance/compliance from sedated animals[edit]
In anesthetized plethysmography, lung resistance and dynamic compliance are
measured directly because the subject is anesthetized.
Depending on the level of sedation, the subject may be spontaneously breathing (SB
configuration) or under mechanical ventilation (MV configuration). A flow signal and a
pressure signal are required to calculate compliance and resistance.

Cerebral blood flow[edit]
Cerebral venous blood flow has been recently studied trying to establish a connection
between Chronic cerebrospinal venous insufficiency and multiple sclerosis. The small
study is not big enough to establish a conclusion, but some association has been
shown.[2]

Bone Marrow Aspiration and Biopsy
Updated: Feb 21, 2013

Overview
Preliminary Assessment
Collection Site
Procedure
Unilateral Versus Bilateral Iliac Crest Biopsy
Postprocedure Care
Slide Preparation
Morbidity/Mortality
Special Concerns
Medical-Legal Pitfalls
Show All
Multimedia Library
References

Overview
The procedure known as trepanning, or trephination, of bone is the oldest surgical practice that continues
to have clinical relevance in modern times. The method dates as far back as the Neolithic period and
initially entailed the drilling of cranial bones as a form of medical intervention for headaches and mental
illnesses. However it was not until 1905, when the Italian physician Pianese reported bone marrow
infiltration by the parasite Leishmania, that this procedure was applied toward clinical evaluation. [1]
In the present day, inspection of the bone marrow is considered one of the most valuable diagnostic tools
to evaluate hematologic disorders.[2] Indications have included the diagnosis, staging, and therapeutic
monitoring for lymphoproliferative disorders such as chronic lymphocytic
leukemia (CLL), Hodgkin and Non-Hodgkin lymphoma, hairy cell leukemia, myeloproliferative disorders,
myelodysplatic syndrome and multiple myeloma. Furthermore, evaluation of cytopenia, thrombocytosis,
leukocytosis, anemia, and iron status can be performed.
The application of bone marrow analysis has grown to incorporate other, nonhematologic, conditions. For
example, in the investigation for fever of unknown origin (FUO), specifically in those patients
with autoimmune deficiency syndrome(AIDS), the marrow may reveal the presence of microorganisms,
such as tuberculosis, Mycobacterium avium intracellulare (MAI) infections, histoplasmosis, leishmaniasis,
and other disseminated fungal infections. Furthermore, the diagnosis of storage diseases (eg. NiemannPick disease and Gaucher disease[3]), as well as the assessment for metastatic carcinoma and
granulomatous diseases (eg, sarcoidosis) can be performed. Bone marrow analysis may reveal toxic
effects of certain offending medications or substances, such as alcohol, or nutritional deficiencies, such
as copper/zinc or vitamin B-12/folate.
Bone marrow analysis can also be performed in patients with idiopathic thrombocytopenia purpura (ITP),
incidental elevated serum paraprotein levels, iron deficiency anemia, polycythemia vera, essential
thrombocytosis, or infectious mononucleosis; but these conditions are often more appropriately
diagnosed by routine laboratory evaluation.[4]
Bone marrow consists of stem cells, which are large, "primitive," undifferentiated cells supported by
fibrous tissue called stroma. There are 2 main types of stem cells and, therefore, the bone marrow
consists of 2 types of cellular tissue. One type of stem cell is involved in producing blood cells and the
other is involved in producing stromal cells, which are responsible for the supporting stroma. For more
information about the relevant anatomy, see Bone Marrow Anatomy.
Sampling of the marrow consists of either aspiration of the cellular component and/or acquirement of
tissue fragments. Aspiration of the marrow, as shown below, has been primarily utilized for cytologic
assessment, with analysis directed toward morphology and obtainment of a differential cell count. Further
sampling allows for material to be directed toward other ancillary test such as cytogenetics, molecular
studies, microbiologic cultures, immunohistochemistry, and flow cytometry. Biopsies, on the other hand,
allow for studies of the marrow’s overall cellularity, detection of focal lesions, and extent of infiltration by
various pathologic entities.[5, 6, 7]

Bone marrow aspiration.

For patient education information, visit eMedicineHealth's Osteoporosis Centerand Cancer Center, as
well as Bone Marrow Biopsy.
Next Section: Preliminary Assessment
READ MORE ABOUT BONE MARROW ASPIRATION AND BIOPSY ON MEDSCAPE

Angiography
From Wikipedia, the free encyclopedia
(Redirected from Arteriography)

Angiography

Intervention

Angiogram showing a transverse projection of
the vertebrobasilar and posterior cerebralcirculation.

ICD-9-CM

88.40-88.68

MeSH

D000792

OPS-301 code:

3-60

Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood
vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. This is
traditionally done by injecting a radio-opaquecontrast agent into the blood vessel and imaging using Xray based techniques such as fluoroscopy.
The word itself comes from the Greek words angeion, "vessel", and graphein, "to write" or "record". The film or
image of the blood vessels is called an angiograph, or more commonly, an angiogram. Though the word itself

can describe both an arteriogram and avenogram, in its everyday usage, the terms angiogram and
arteriogram are often used synonymously, whereas the term venogram is used more precisely. [1]
The term angiography is strictly defined as based on projectional radiography; however, the term has been
applied to newer vascular imaging techniques such as CT angiography and MR angiography. The term isotope
angiography has also been used, although this more correctly is referred to as isotope perfusion scanning.
Contents
[hide]

1 History
2 Technique
3 Uses

o

3.1 Coronary angiography

o

3.2 Microangiography

o

3.3 Neuro-vascular angiography

o

3.4 Peripheral angiography

o

3.5 Post mortem CT angiography for medicolegal cases

4 Complications

o

4.1 Coronary angiography

o

4.2 Cerebral angiography

o

4.3 Additional Risks

5 See also
6 External links
7 References

History[edit]
The technique was first developed in 1927 by the Portuguese physician and neurologist Egas Moniz at
the University of Lisbon to provide contrasted x-ray cerebral angiography in order to diagnose several kinds of
nervous diseases, such as tumors, artery disease and arteriovenous malformations. He is usually recognized
as one of the pioneers in this field. Moniz performed the first cerebral angiogram in Lisbon in 1927,
and Reynaldo Cid dos Santos performed the first aortogram in the same city in 1929. With the introduction of
theSeldinger technique in 1953, the procedure became markedly safer as no sharp introductory devices
needed to remain inside the vascular lumen.

Technique[edit]

Depending on the type of angiogram, access to the blood vessels is gained most commonly through
the femoral artery, to look at the left side of the heart and at the arterial system; or the jugular or femoral vein,
to look at the right side of the heart and at the venous system. Using a system of guide wires and catheters, a
type of contrast agent (which shows up by absorbing the x-rays), is added to the blood to make it visible on the
x-ray images.
The X-ray images taken may either be still images, displayed on an image intensifier or film, or motion images.
For all structures except the heart, the images are usually taken using a technique called digital subtraction
angiography or DSA. Images in this case are usually taken at 2 - 3 frames per second, which allows
the interventional radiologist to evaluate the flow of the blood through a vessel or vessels. This technique
"subtracts" the bones and other organs so only the vessels filled with contrast agent can be seen. The heart
images are taken at 15-30 frames per second, not using a subtraction technique. Because DSA requires the
patient to remain motionless, it cannot be used on the heart. Both these techniques enable the interventional
radiologist or cardiologist to see stenosis (blockages or narrowings) inside the vessel which may be inhibiting
the flow of blood and causing pain.

Catheterization Lab

Uses[edit]

Catheterization in selective angiography

Finger angioma

Coronary angiography[edit]
Main article: Coronary angiography
One of the most common angiograms performed is to visualize the blood in the coronary arteries. A long, thin,
flexible tube called acatheter is used to administer the X-ray contrast agent at the desired area to be visualized.
The catheter is threaded into an artery in theforearm, and the tip is advanced through the arterial system into
the major coronary artery. X-ray images of the transient radiocontrastdistribution within the blood flowing inside
the coronary arteries allows visualization of the size of the artery openings. Presence or absence
of atherosclerosis or atheroma within the walls of the arteries cannot be clearly determined. See coronary
catheterization for more detail.
To detect coronary artery disease, Computed Tomography (CT) Scan is better than Magnetic Resonance
Imaging (MRI). The sensitivity and specificity between CT and MRI were (97.2 percent and 87.4 percent) and
(87.1 percent and 70.3 percent), respectively. Therefore CT (mainly multislice CT) is more accepted, more
widely available, more favored by patients, and more economic. Moreover, CT requires shorter breath-hold
time than MRI.[2]

Microangiography[edit]
Microangiography is commonly used to visualize tiny blood vessels.

Neuro-vascular angiography[edit]

Another increasingly common angiographic procedure is neuro-vascular digital subtraction angiography in
order to visualise the arterial and venous supply to the brain. Intervention work such as coil-embolisation
of aneurysms and AVM gluing can also be performed.

Peripheral angiography[edit]
Main article: Peripheral artery occlusive disease
Angiography is also commonly performed to identify vessel narrowing in patients with leg claudication
or cramps, caused by reduced blood flow down the legs and to the feet; in patients with renal stenosis (which
commonly causes high blood pressure) and can be used in the head to find and repair stroke. These are all
done routinely through the femoral artery, but can also be performed through the brachial or axillary (arm)
artery. Any stenoses found may be treated by the use of atherectomy.

Post mortem CT angiography for medicolegal cases[edit]
Post mortem CT angiography for medicolegal cases is a method initially developed by the Virtopsy group.
Originating from that project, both watery[3] and oily[4] solutions have been evaluated.
While oily solutions[4] require special deposition equipment to collect waste water, watery[3] solutions seem to be
regarded as less problematic. Watery solutions also were documented to enhance post mortem CT tissue
differentiation whereas oily solutions were not. Conversely, oily solutions seem to only minimally disturb
ensuing toxicological analysis, while watery solutions may significantly impede toxicological analysis, thus
requiring blood sample preservation before post mortem CT angiography.[5]

Complications[edit]
Coronary angiography[edit]
Coronary angiographies are common and major complications are rare. These include cardiac arrhythmias,

damage, blood clots (which can cause heart attack or stroke),hypotension and pericardial effusion. Minor
complications can include bleeding or bruising at the site where the contrast is injected, blood vessel damage
on the route to the heart from the catheter (rare) and allergic reaction to the contrast.[6]

Cerebral angiography[edit]
Major complications in cerebral angiography are also rare but include stroke, an allergic reaction to
the anaesthetic other medication or the contrast medium, blockage or damage to one of the access veins in the
leg, or thrombosis and embolism formation. Bleeding or bruising at the site where the contrast is injected are
minor complications, delayed bleeding can also occur but is rare.[6]

Arteriography

Related Terms
Angiography
Digital Subtraction Arteriography (DSA)

Specialists
Cardiovascular Internist
Radiologist
Vascular Surgeon

Comorbid Conditions
Diabetes mellitus

Factors Influencing Duration
There is usually no disability after arteriography. However, disability may be associated with any
complications that may occur or as a result of the findings of the procedure.

Medical Codes

ICD-9-CM: 88.4, 88.40, 88.41, 88.42, 88.43, 88.44, 88.45, 88.46, 88.47, 88.48, 88.49
Definition

© Reed Group
Arteriography is the radiologic examination of arteries using a contrast medium that is injected into an
artery to make arteries visible. This type of examination can be performed most often using x-ray,
althoughmagnetic resonance imaging (MRI) andcomputed tomography(CT scan) may also be used.
When an x-ray or CT scan study is performed, a liquid, radio-opaque dye is used.
Digital subtraction arteriography (DSA) has for the most part replaced film angiography. DSA uses
computer techniques to process arteriographic images. In DSA, images of bone are removed (subtracted)

from the x-ray image, leaving only the image of the artery for study. This gives enhanced details useful for
diagnostic and therapeutic purposes. Use of DSA is especially helpful for arteriography of the carotid and
cerebral arteries of the head, since they are adjacent to or surrounded by bone. DSA images also have
the advantage of being projected on a video screen in real time, allowing the radiologist to determine
immediately whether he or she has acquired the information the physician needs or to immediately
terminate the procedure if there is a complication. Digital images can also be easily transmitted over the
Internet for consultation.
Arteriography is usually performed under local anesthesia. It may also be performed in the operating
room under general anesthesia during arterial graft surgery (such ascoronary bypass surgery). The
procedure can take as little as a few minutes or up to 2 to 3 hours. An alternative to arteriography is the
use of Doppler ultrasound.
Source: Medical Disability Advisor

Reason for Procedure
Arteriography is done before operating on an artery to "see" its interior. This helps a physician decide if
surgery is necessary and provides a road map for the surgeon to know exactly where to operate and how
extensive an operation is necessary. Arteriography is performed before heart bypass surgery, aortic
aneurysm repair, and other types of arterial surgery.
Arteriography can be used for diagnosis and before certain treatments that may eliminate the need for
surgery, such as percutaneous transluminal angioplasty (PTA). PTA consists of an inflatable balloon
being guided into a plugged artery, where it is inflated in order to compress and push fatty plaque
formations to the side within the artery, often followed by placement of a stent to keep the vessel open.
Other therapeutic uses of arteriography include therapeutic embolism (injection of a foreign substance
into an artery to reduce or shut off the blood supply to a tumor or to stop bleeding from a blood vessel),
delivery of a medication to control bleeding directly into the bleeding vessel, and treatment of tumors by
infusing medication directly into the artery supplying the organ containing the tumor.

How Procedure is Performed
Arteriography is usually performed in a radiology or diagnostic-imaging department such as a heart
catheterization laboratory. It can also be performed in the operating room during actual surgery. Except
during surgery, when the individual is sedated with general anesthetic, a local anesthetic is used.
When x-ray is used, the procedure is done on an artery in the groin, arm, or neck. The groin (femoral)
artery is used most often, although use of the arm (brachial) artery is being used more often than in the
past. A long, slender, hollow tube (catheter) is inserted into the artery through a very small incision. The
contrast medium is then injected through the catheter into the artery. The contrast media moves through
the body, making arteries in other locations visible to x-rays.
Once the x-ray images have been made, the catheter is removed. Pressure is applied to the skin over the
entry site to stop any bleeding. Stitches are usually unnecessary. The individual is observed in the
recovery room or hospital room for 6 to 8 hours. The individual is then discharged the same day or the
next morning.

Prognosis
The individual should return to performing all usual activities within 1 to 3 days after arteriography. If a
complication of the procedure occurs, therapy will be required, and the individual may be delayed in
returning to work.

Complications
The most common complication of arteriography is formation of a blood clot (thrombus) in the artery at the
entry site. Other complications include an allergic reaction to the dye, bleeding from the puncture site,
dislodgment of plaque from the inside of the artery (embolization), separation of the wall of the artery
(dissection), infection, and stroke.Dehydration may increase the risk of kidney complications from the xray dye because of reduced blood flow to the kidney. If an individual has impaired kidney function before
arteriography, the risk of worsening kidney functioning afterward increases, and certain medications
and/or fluids may be given to the individual to help prevent this. Individuals taking certain medications for
diabetes may develop low blood sugar (hypoglycemia). Entry site complications are more frequent if there
is hardening of the arteries (atherosclerosis) at the entry site. If arteriography is done during surgery
(intraoperatively), complications may arise due to the general anesthetic used.

Return to Work (Restrictions / Accommodations)
Ordinary walking and a return to work the same day or the next day are usually allowed. If work involves
lifting more than 20 pounds or a lot of bending (if the groin site was used), 2 or 3 days off work are
recommended to reduce the chance of re-bleeding from the entry site. Bending of the groin or elbow at
whatever site was used for performance of the arteriography should be avoided for 1 day. A longer
restriction of activity may be required if an individual sustained a complication from the procedure.

References

General
"Arteriography." American Heart Association. 19 May. 2005. American Heart Association, Inc. 19 May
2005 <h

Cardiopulmonary Resuscitation (CPR)

CPR how to with detailed CPR steps and CPR instructions based upon 2010 CPR
guidelines.

This website is designed to provide comprehensive information related to
the delivery of Cardiopulmonary Resuscitation (also known as CPR).
Increased public knowledge and awareness on how to respond to cardiac
arrest situations and deliver high qualityCPR can make the difference
between life and death for victims of sudden cardiac arrest.

What is Cardiopulmonary Resuscitation (CPR)?
Cardiopulmonary Resuscitation or CPR
is an emergency medical procedure
indicated in victims of cardiac arrest
and sometimes in victims of severe
symptomatic cardiovascular and
circulatory compromise. A victim of
cardiac arrest is defined as a person
who is unresponsive, pulseless, and
apneic (or exhibiting agonal
respirations). Agonal respirations are ineffective breaths produced with poor
respiratory effort, volume, quality, or rate that are unsustainable of life.
CPR technique typically includes external delivery of chest compressions and
ventilations/breaths. CPR produces circulation in the absence of
spontaneous cardiac output and allows for delivery of oxygen rich blood
throughout the body. Effectively delivered CPR prolongs cellular death and
may allow time for more definitive care to be delivered.

Cardiopulmonary Resuscitation (CPR) Facts & Statistics
The Sad Facts: There are approximately 350,000 out of hospital cardiac
arrests each year in the United States. Of those cardiac arrests: 80% occur in
a private residential setting at someone's home. 50% of the time there is
another person present or immediately available during the event. However
only 6% survive. The number one reason for this terrible statistic is the lack
of public CPR knowledge and training. People simply do not know what to
do. The goal of this website is to increase public knowledge and improve
this terrible statistic.

Paying it Forward: We ask you to consider who would be there to take care
of you if you were the victim of cardiac arrest. Would they know what to do?
If not - We ask that you share this website and knowledge contained with
your friends and loved ones. Knowledge is power and can make the
difference between life and death. Face to face, Facebook, Twitter, or
Email - the life you help save, might be your own.

Emergency Situation Considerations

Personal Safety
Your number 1 priority in any situation should be your own personal safety.
You should never put yourself in extreme danger to help someone else. You
can not do any good for anyone if you become injured or hurt. If you are
uncomfortable or in fear for yourself - retreat to safety and await
professional help.

Nature of Emergencies & Staying Calm
Emergencies by nature are stressful and take a toll on everyone involved. To
be able to help someone else you must remember to remain calm. You must
make rational decisions based upon processing rapid information related to
the situation you are in without influence of emotion. Failure to remain
calm and/or separate emotion may cause you to make poor decisions. These
poor decisions may cost you or someone else their life. Calm rescuers also
equate to calm victims / bystanders.

Emergency Preparedness
Before an emergency happens is the proper time to start preparing for it.
Once the situation occurs there is little opportunity for planning and
organization. In your daily life, look around and think about common
situations that may occur and how you should respond to them.
What would you do if a coworker collapsed while at work? Do you know the
address to your workplace? Do you have an AED or First Aid Kit available? If
so, where are they located? Are you familiar with their contents and
operations?
Simply taking a few minutes to figure what resources you have, where they
are located, and how they work today -- before you need to use it for a real
emergency -- may make a difference.
Overcoming Hurdles:
Persons faced with cardiac arrest situations often are hesitant to provide
care due to fear of doing something wrong or making things worse.
Remember that persons in cardiac arrest are clinically dead and there is
nothing you can do to hurt them. Doing something is always better than
doing nothing. The opportunity of survival you provide by providing CPR can
mean the difference between life and death. If suspect someone needs CPR,
you start the steps of CPR, and victim does not show any signs of life - CPR
is indicated. Continue care until trained help arrives and takes over.

Calling 911

If presented with an emergency situation that exceeds your available
resources or you are unsure what to do – someone needs to call 911.
911 is a universal number across the United States that should connect you
to your local Police/Fire/EMS dispatch center. When you call 911 remember
to stay calm and answer each and every question asked to the best of your
ability.
Remember Who, What, Where, and How! Who?

This includes who you are and who needs help.
What is going on? This determines if a fire truck, police officer, or
ambulance is needed.
Where? Give the complete address if known. If not, describe the
location by looking around and giving any information you can see.
How to reconnect? Always give the telephone number in which you are
calling from or can be reached at should you become disconnected.
In addition the 911 dispatcher may ask you a seemingly endless list of
questions. Try to remember to stay calm and patient when talking to a 911
dispatcher. Each question is important and helps deliver the most
appropriate help to you and those in need. Based on your answers and the
given situation the 911 dispatcher may help walk you through any steps that
need to be completed before help arrives. Remember to listen carefully and
do as instructed. Always ask questions if you do not understand what you are
supposed to do.
NEVER PUT YOURSELF IN DANGER. NEVER HANG UP FROM 911 UNLESS
TOLD TO DO SO BY THE DISPATCHER.
Know How To Use The Phone: If you have to dial 9, 7, or * to get an
outside line - 911 may be 9911, 7911, or *911.

Cardiopulmonary Resuscitation (CPR) for Adults - CPR
How To
Quick Guide of Steps of CPR for Adults:
Ensure Personal Safety
Assess Victim (Tap and Shout)
Assess Breathing
Call 911
Circulation: Begin Chest Compressions
Airway: Open the Victims Airway
Breathing: Provide Rescue Breaths
How to perform CPR for Adults:
Scene Assessment/Personal Safety:

You must make your personal safety the top priority in any emergency
situation. If you become injured or killed you will not be able to do any good
for anyone else. You becoming injured will take resources away from the
original victim possibly worsening their outcome. Things may not be as they
appear. Evaluate the scene to make sure there is no risk to yourself. Never
put yourself in a situation you are not comfortable with. Think BEFORE
Acting/Responding. After insuring your safety, evaluate the scene for clues,
resources, and additional victims as your approach. Having good situational
awareness helps you better help others. Remember whose emergency it is.
THERE IS NO WAY OF CHANGING THE PAST OR RESERVSING WHAT HAS HAPPENED TO ANY
VICTIM. YOU WANT TO MAKE THINGS BETTER - NOT WORSE. TRY TO REMAIN CALM.

Assess the Victim:

Upon finding a suspected victim of cardiac arrest and insuring your own
safety - you should assess the victim for responsiveness and determine the
appropriate actions for that person. You must remember that things may not
be as they appear. Is every person found laying on a sidewalk or in a public
place in need of CPR? They may be simply asleep; under the influence of
drugs, alcohol; perhaps be homeless; or even mentally ill. You must
determine what situation you are faced with before taking any other
actions. To assess the victim you should tap and shake the victim physically
and yell at the victim "ARE YOUR OKAY?". You want to use enough stimulus

that would awaken an average person. The victim may be deaf or hard of
earring - by physically shaking and tapping the victim - we know with
certainty their status.
Assess Breathing:

After Tapping/Shouting you should assess the victim for breathing.
Remember Look, Listen, & Feel. Lower your head down and LOOK at the
victims chest; LISTEN for coming out the victims mouth and nose; and FEEL
for movement on the victims chest. You should Look, Listen, and Feel for 5
to 10 seconds unless it obvious the victim is not breathing (Blue, etc.). If the
victim is NOT breathing or breathing normally - you should continue with the
steps of CPR.
Call 911 / Getting Additional Resources:

If your assessment of the victim determines that they are unconscious &
unresponsive or not acting appropriately you must call 911 and/or obtain
additional resources. If you fail to call 911 or obtain additional resources
you will be responsible for providing care indefinitely. An ambulance does
not magically appear when someone is injured, hurt, or in cardiac arrest.
You must remember to activate Emergency Medical Services (or other
appropriate resources) as soon as possible.
ABC's of Life: A = Airway, B = Breathing, C = Circulation - Now C.A.B.

ABC is now CAB: CPR Compressions now are performed prior to opening
the airway and giving breaths.

Circulation: Checking For A Pulse: Layperson rescuers should not check for
a pulse while performing CPR. The average person has little practice in
obtaining a pulse therefore it is unrealistic to expect accuracy during an
emergency situation. You should assume that unless the victim wakes up
during your assessment or shows signs of life during CPR that the person is
pulseless and needs CPR to be continued. Healthcare Providers or persons
trained in checking for a pulse may do so if they feel comfortable. If you
check for a pulse and do not feel a pulse or are not sure if a pulse is present
- begin CPR immediately.
If a person is unresponsive, has a pulse, and CPR is performed: no ill effect
(other than rib fracture) or cardiovascular damage will occur. Therefore,
always err on the side that the victim is pulseless and begin CPR as soon as
possible.
Circulation: Chest Compressions

The fundamental principle of CPR is that we want blood and oxygen
circulating throughout the body at all times. Circulation equates to
potentially prolonging and mitigating cellular injury and death. The primary
intervention to be performed for circulation is Chest Compressions. Chest
Compressions circulate blood and oxygen. When performing CPR with rescue
breathing, give 30 compressions followed by 2 breaths (30:2 Compressions to
Breaths Ratio). Transition from compressions to breaths and back to
compressions as quickly as possible. Your goal should be to begin chest
compressions within 10 seconds of discovery of the victim and to not
interrupt compressions for more than 10 seconds for any reason unless
absolutely necessary.

How to Perform Chest
Compressions
Make sure the victim is laying flat on their back, face up, on a HARD FIRM
SURFACE. The floor is typically the best option in most situations. The
transition of the victim from their location to the floor does not have to be a
graceful one. You must get them on the floor (or other firm surface) as
quickly as possible. Recognize that if the victim is not on a firm surface
compressions will likely move the body up and down and not compress the
chest (Visualize doing compressions on a water bed).
Next, quickly remove any clothing covering the chest. This allows us to find
the correct location to perform compressions and use an AED when it
arrives.
Locate the center of the chest, between the breasts and place the palm of
one hand on top of the lower half of the sternum. Place the second hand on
top of the first hand in a manner that is comfortable for you. You may
overlay or interlock your fingers. Position yourself over the victim and use
your entire body to push up and down on the persons chest. Keep you
elbows locked and think of moving at the waist. This ensures you use your
entire body to perform compressions. If you use your arms and not your

body - your arms will become fatigued quickly and you will not be pushing at
the right rate and depth.
Compress the chest at the rate of at least 100 compressions per minute.
Think of the beat of the song "Staying Alive" by the Bee Gees. The beat of
"Staying Alive" is 100 beats per minute. If you match compressions with this
song - you will be performing compressions at the right speed. Remember to
pace yourself so not to get fatigued. After each compression, allow the
chest to return to its normal position before compressing again. This chest
recoil allows the heart to refill with blood and provide the most effective
CPR possible.

If performing rescue breathing, perform 30 compressions, perform a headtilt/chin-lift, give two rescue breaths (looking for chest rise and fall) and
resume compressions as quickly as possible. If performing "Compression
Only CPR" simply compress the chest at the rate of 100 compressions per
minute without interruption or delay.
Remember that when CPR is not being performed, blood and oxygen are not circulating, and
cellular injury and death may occur.

2 Rescuers Present: If another rescuer is arrives or is present during the
rescue effort perform CPR as described above expect you may alternate and
switch roles as needed. One rescuer should perform 30 compressions and the
second rescuer provide 2 rescue breaths. You should change roles every 2
minutes (or 5 sets of 30:2) or as needed to prevent fatigue. When working
with another rescuer counting out loud when doing compressions will allow
them to know when to give breaths. Teamwork is very important and each
rescuer should evaluate the rescue effort and provide feedback as needed.
Rib Fracture: While performing CPR rib fracture is common. You may feel ribs break, feel or
hear bone rubbing on bone, or see free floating ribs on the victims chest. Chest compressions
should continue without delay or modification. If the person survives the cardiac arrest their
ribs will heal. Saving their life out weighs the risk of rib fracture.

To perform chest compressions effectively:
1.) Push Hard and Push Fast. Pushing hard and pushing fast helps keep
circulation moving.
2.) Continue CPR continuously without delay or pause unless absolutely
required.
Reasons to stop or pause CPR include: The person wakes up/shows signs
of life, someone else takes over, to use an AED, or you can no longer
continue.
3.) Aim for the rate of at least 100 compressions per minute. Think
"Staying Alive".
Airway: Opening the Airway

When a person becomes unconscious, they
loose all muscle tone. The tongue being a muscle relaxes and may block the
airway (trachea/windpipe) of the victim. The tongue is the most common
cause of airway obstruction in an unconscious adult. To mitigate this and
reopen the victims airway, we must perform a physical intervention to lift
and move the tongue out of the way. The maneuver used to open a victims
airway is called a head tilt/chin lift.
With the victim laying face up on a hard firm surface place one hand on the
forehead of the victim while grasping the bony portion of the chin with the
other. Tilt the head and lift the chin at the same time. This lifts the tongue
and creates a pocket for oxygen to travel.
When you open the victims airway you may hear sounds of oxygen or gasses
escaping and/or may see fluid, vomit, or froth escape from the victims

mouth. Anything blocked from the tongue in the trachea will potentially
escape when the airway is opened. Do not confuse this with breathing or
stop CPR if this occurs.

Breathing: Rescue Breaths
Rescue breaths are the process of giving artificial breathing to someone who
isn't breathing on their own. When giving rescue breathing, give just enough
air (volume) to see the chest rise. Giving too much volume may cause harm
to the victim. Simply think of lungs as nothing more than balloons. If you
over inflate/hyperventilate a balloon it pops; the same is potentially true
with a human lung. In addition to causing injury to the lung from over
inflation and hyperventilation - may cause air to enter the stomach which
may induce or cause vomiting. Vomiting is dangerous as it may lead to
aspiration and development of pneumonia if the victim survives.
Breathing: Mouth to Mouth

Mouth to Mouth breathing is
considered the easiest and most readily available option as it does not
require any special equipment to perform. Mouth to Mouth breathing is
performed by opening the victims airway (head-tilt/chin-lift), covering the
victims mouth completely with your mouth, pinching the victims nose (to
keep the oxygen from escaping back out the nose), and giving a regular
breath for about 1 second into the victim. When giving the breath you
should see the chest rise. Let the victim exhale and give the second breath
just as you did with the first breath. If you do not see the chest rise and fall
with each breath, readjust the head, making sure you have the airway open
and attempt the breaths again. If the breaths do not make the chest rise
and fall for a second time - move on to circulation and compressions.
Despite the typically low risks of exposure during mouth to mouth breath
many people are hesitant to provide mouth to mouth breathing to someone
who they do not know. Mouth to Mouth breathing risks are real and may
expose the rescuer to viral infections such as H1N1, the Flu, or Herpes.
Rescuers should use their judgment and internal comfort when considering
who and when to provide rescue breathing.
Breathing: Mouth to Mask

Mouth to Mask Breathing is the delivery of rescue
breaths through a barrier mask to protect the rescuer from becoming
exposed to the victims bodily fluids. Barriers devices such as a pocket mask
should be used to provide rescue breathing when available and delivering
rescue breaths.
Pocket Masks are usually made of plastic and contain a one way value
designed to limit exposure to the rescuer to exhaled air, bodily fluids, and
disease process.
To use the mask, place it on the victims face with the pointy end over the
bridge of the nose. Place one hand over the top of the mask holding it firmly
on the face, Place the second hand on the bottom portion of the mask while
grasping the chin; perform a head tilt/chin lift. Deliver breaths as in mouth
to mouth breathing except place your mouth on the one way valve. Deliver
each breath for about 1 second; looking for the chest to rise.
Breathing: Rescue Breathing without Compressions:

During a major medical event and
sometimes prior to cardiac arrest, you may be faced with a victim who is
not breathing or not breathing effectively but still is maintaining adequate

circulation and perfusion. When faced with these types of situations if in
your opinion the victim does not yet need CPR with compressions but
exhibits any signs or symptoms of poor oxygen exchange, Rescue Breathing
should be considered.
To provide rescue breathing: (after contacting 911 or obtaining additional
resources): 1.) Open the victims airway with a head-tilt chin-lift as in CPR;
2.) Give 1 Rescue Breath Every 5 to 6 Seconds for Adults OR Every 3 to 5
Seconds for Pediatric Victims.
Be sure with each breath to witness the chest rise and fall. Count each
second slowly (One-One Thousand, Two-Mississippi) between rescue breaths
to avoid hyperventilation or gastric inflation (air getting into the stomach)
which may induce vomiting.
If while facing an emergency, you can not remember how often to deliver a
Rescue Breath to a victim of any age: 1.)Remain Calm 2.)Focus on Your Own
Breathing 3:)Provide a Rescue Breath to the victim each time you breath
(You Breath - They Breath) until other trained help arrives.

Hands Only Cardiopulmonary Resuscitation (CPR)
Compression Only Cardiopulmonary Resuscitation
(CPR)

Hands Only CPR / Compression Only CPR is a research
tested alternative method of delivering CPR without rescue breaths.
Rescuers during Hands Only CPR / Compression Only CPR should focus on
continued non-stop effective compressions.
How It Works: Hands Only CPR / Compression Only CPR works by primarily
circulating the oxygen inspired by the victim prior to collapse. This
preexisting oxygen is circulated during compressions to attempt to delay
desaturation and cellular death. The amount of oxygen available and the
time of efficiently with Hands Only CPR / Compression Only CPR is variable

upon the victim and circumstances related to the cardiac arrest. Regardless,
Hands Only CPR / Compression Only CPR is a viable alternative option for
providing cardiac arrest care over doing nothing; and is perfect for
situations in which you discover or witness a sudden cardiac arrest, have no
barrier device, and you do not feel comfortable giving unprotected mouth to
mouth ventilations.

Cardiopulmonary Resuscitation (CPR) for Children
Cardiopulmonary Resuscitation (CPR) for Infants
Differences in CPR for Children & Infants:

Defining a child: A child is a victim who is over the age of 1 and up to the
age of puberty. Puberty for this context is defined as breast development in
females and underarm or facial hair in males. Puberty is used as the
establishment of adulthood as developmental changes may effect aspects of
CPR. In addition to puberty the overall size of the victim should be
considered due to the current epidemic of obese children in the United
States. If the victim is the size of an adult - treat them as an adult and not a
child - regardless of age or puberty status.
Reason for Cardiac Arrest in Children/Infants: Children and Infants suffer
from cardiac arrest typically as a result of a respiratory event such as
choking or respiratory arrest. Not from a cardiac condition - It is uncommon
to hear of a child or infant having a heart attack. Children and Infants
typically do not have a history of high blood pressure, smoking, or other
conditions that are applicable to adults. Due to children and infants likely
going into cardiac arrest due to respiratory event, we must recognize that
oxygenation and circulation need to be initiated as quickly as possible for
these age groups.

Hypoxia (or lack of oxygen inside the body) is a reversible cause of cardiac arrest. If
oxygenation and circulation are performed quickly and effectively the cardiac arrest may
improve or allow the person to recover.

When to Call or Get Help for Children and Infants in Cardiac Arrest: Due
to children and infants going into cardiac arrest most likely to respiratory
cause; one must consider the value of outside resources in the life saving
effort. You should recognize that time is the enemy, especially in pediatric
victims, and delay in treatment or care may result in a poor outcome. The
sooner care is initiated for a child or infant - the higher the chance of
survivability. Therefore there are special guidelines for when to obtain or
call 911 when faced with a pediatric cardiac arrest.

If you are ALONE and FIND an infant or child in
cardiac arrest: Perform the steps of CPR immediately without delay for 2
minutes or 5 sets of 30:2 before leaving the pediatric victim to get help or
call 911. Due to finding the child and the unknown time involved since
collapse, delaying starting CPR may result in cellular injury or death. By
performing the steps of CPR for 2 minutes or 5 cycles of 30:2, we circulate
blood and oxygen potentially restarting the clock on a poor outcome. This
allows us to build the pediatric victim back up with oxygenation before
leaving to call 911 or obtain help without fear of causing more harm (at
least for a few minutes).
If you witness the pediatric victim collapse or have someone else
around: Treat the victim as an adult. Get additional resources and Call 911
(or have someone else do it) immediately then return to the victim and
begin CPR.
Cell Phones: If you are alone and have a cell phone it may be possible to call 911 & begin the
steps of CPR at the same time regardless if you witness the arrest or not. Remember that time
is the enemy.

ABC's of Life for Children (1 to Puberty): CAB - Compressions, Airway,
Breathing

Circulation: Same as an Adult. Remember to
Push Hard and Push Fast. Do not hesitate or restrict compressions due to the
smaller size of the child. Recognize that performing poor compression
equates to poor circulation and cellular injury and death. Attempt to push
1/2 to 1/3 the chest depth of the child (approximately 2 inches). If the child
is small in size, you may use one hand instead of two when performing
compressions. You may use the second hand to maintain an open airway to
allow for potential CPR induced ventilation; and stabilize the child from
moving during compressions, if you prefer.
Airway: Same as an Adult except look in the airway for a potential choking
object that potentially could be removed.
Breathing: Same as an Adult. If giving rescue breaths, give a lower volume
of air when giving breaths. Give just enough breath to see the chest rise.
ABC's of Life for Infants (Birth to Age 1): CAB - Compressions, Airway,
Breathing

Circulation: Compressions have to performed
differently for infants than they would be for larger children and adults due
to their smaller size. To perform compressions on an infant, place the infant
on a flat hard surface, face up, and locate the middle of the chest between
the breasts. Place two fingers of one hand on top of the sternum about a
fingers tips length below the nipple line. Place the second hand on the
infants head to maintain an open airway and to stabilize the victim. Push on
the chest using the two fingers at the rate of at least 100 compressions per
minute at a depth of 1/3 the chest depth. If giving CPR with rescue
breathing perform 30 compressions to 2 breaths (30:2 ratio).
Airway & Breathing: Same as a Child.

Automated External Defibrillators

Automated External Defibrillator's (or AED's) are
devices that treat the most common cause of sudden cardiac arrest by
delivering a electrical shock to a persons body.
What an AED treats is an abnormal heart rhythm called Ventricular
Fibrillation (or V-Fib) that causes the heart to stop circulating blood. V-Fib is

a heart condition in which the ventricles of the heart quiver instead of
mechanically pumping. The most effective treatment for V-Fib is CPR and
use of a defibrillator. The longer it takes for CPR and an AED to be used, the
less likely a person is to survive V-Fib. CPR should be stopped and an AED
applied and used as soon as it is available.
Automated External Defibrillators are designed to allow anyone to use them
regardless if they have been formally trained on their operations. AED's
accomplish this through use of voice instructions, pictures, and prompts. An
AED will only deliver a shock if indicated and is safe when used correctly.

Quick Guide to Using an AED:
1.) Open AED and Turn Unit On.
2.) Attach AED Pads to victims bare chest.
3.) Ensure AED Pads are attached to AED.
4:) Follow Prompts of the AED.
5:) Clear the Victim when Analyzing and Deliver Shock if indicated.

6:) Continue CPR starting with Chest Compressions.
7.) Follow AED instructions until emergency personnel arrive.
AED's function by taking an EKG of the victims heart to analyze the
electrical activity in an attempt to determine if the victim is in V-Fib or
another heart rhythm. If the AED analysis indicated V-Fib, a shock will be
indicated and may be delivered by the rescuer and AED according to the
device's operating instructions. If the AED analysis finds any other rhythm
than V-Fib - a "No shock" instruction will be issued - and the AED will not
allow a shock to be delivered.
Pad Placement: AED pads typically go around the heart and are placed on the upper right side
of the chest below the collar bone and on the lower left side below the nipple line near the
armpit. The electricity delivered by an AED will travel in both directions between these two
pads.

Rescuers using an AED must always listen to the instructions of an AED. The
AED will advise not to touch the patient while it is analyzing the victims
heart and again if a shock is indicated. If the victim is touched or moved
during analysis, the AED may interrupt those movements and cause a
potential false positive for V-Fib. If any person is touching the victim when a
shock is actually delivered, they may receive some of the shock - which may
cause injury or even death. If you are operating an AED: verbally yell and
physically look head to toe to make sure no person is touching when the
victim when the AED advises not to touch the victim.
The electricity delivered by an AED during a shock stuns the heart in an
attempt to stop the abnormal rhythm. This stunning of the heart may halt
the abnormal ventricular quivering and allow the heart to recover back into
a regular rhythm.
An AED does NOT restart the heart or fix a "flat line" as often shown on television. A flat line
represents that there is no heart electrical activity at all. A flat line usually represents clinical
death as it is rare to recover from a flat line rhythm. Recognize an AED attempts to correct
the electrical system of the heart that is malfunctioning - not jump start it. If an AED
recognizes a "flat line" it will indicate "No Shock Advised" and instruct you to resume CPR.
Shocking a flat line will NOT benefit the patient and will not be allowed by an AED.

If a shock is indicated and delivered, the heart may take up to 10 minutes to
recover from the cardiac arrest. Therefore, immediately after delivering a
shock (or a "No Shock" indication) the rescuers must resume CPR with
compressions to help mechanically get the heart beating again.
Effectiveness of a shock is greatly affected by how well CPR is performed
immediately thereafter. Do 5 sets of 30:2 or 2 minutes of CPR. The AED will

automatically stop and give instructions exactly every 2 minutes. Repeat the
process of operation and perform the tasks indicated by the AED. Remember
when resuming CPR after AED usage to always being CPR with chest
compressions.
When a shock is delivered the victim will often convulse. You may also witness an arch of
electricity travel across the victims body, smell burning hair or skin, or see smoke. This is
normal as a large amount of electricity is entering the victims body. Continue with CPR and
AED usage as indicated.

Once an AED is placed, never remove the pads from the victims chest or
turn the AED off until instructed to by trained healthcare professionals. If
the victim wakes up or recovers they may suffer from V-Fib again and
require additional AED treatment.
Special Considerations When Using an AED:
1:) Hairy Chest: If the victim has a hairy chest you will need to remove the
hair prior to placing the AED pads on the victims chest. You may do this with
a razor that is typically found with an AED or by attaching one set of AED
pads and pulling them off forcibly removing the hair. You should ensure you
have another set of AED pads prior to using one set to remove hair or you
may not be able to use the AED. Leaving hair in place may cause the AED
pads not make contact with the patients chest and cause the shock to be
ineffective.
2:) Medication Patches: If the victim has a medication patch on their skin in
the area the AED pads are to be placed you must remove them prior to
attaching the AED pads. Use gloved hands to remove the medication patch.
Medications patches may divert the shock or represent a burn hazard if not
removed.
3:) Covered in water: If the victim is covered in water or sweat attempt to
dry the chest prior to applying the AED pads. Moisture may divert the shock
from the heart.
4:) Implanted Pacemakers or Defibrillators: If the victim has an implanted
pacemaker or defibrillator continue to use an AED as otherwise indicated for
other patients. Ensure the AED pads are at least an inch away from the
victims device prior to delivering a shock. You continue to use an AED as it is
unknown if the implanted device is functioning correctly. An implanted

pacemaker or defibrillator will look like a small lump underneath the skin
usually on the upper left side of the chest near the heart.
5:) Pediatric Patients: An AED may be used for any victim of any age.
Pediatric pads deliver a smaller shock and should be used if available when
dealing with infants and children. If pediatric pads are not available, use the
adult pads as long as they do not overlap or touch. You may place AED pads
with one pad on the front and one pad on on the back of very small victims.
It should be noted many AED's will not have pediatric pads due to financial
and logistical reasons.
6: ) Fully Automated AEDS: Fully automated AED's are devices they do not
require a rescuer to push a button to deliver a shock to a victim once
applied. It is imperative to always listen to an AED and follow the
instructions given. If using a fully automated AED it may deliver a shock at
anytime and pose injury or death to you or other rescuers if touching the
victim when a shock is delivered.

Healthcare Provider CPR / Professional Rescuer CPR
Considerations
Healthcare Providers and Professional Rescuers when performing CPR should
consider the following considerations:

Use of BVM or Bag Value Mask: A bag valve
mask is a device that is commonly used in healthcare settings to deliver
rescue breathing to person who is not breathing or is breathing
ineffectively. A BVM delivers positive pressure ventilation and forces the
volume of the air in the device into the victims lung. The device may be
used with or without oxygen. If used with oxygen, high flow oxygen (greater
than 12 liters per minute) should be used. Room air contains approximately
21% oxygen; with high flow oxygen attached to a BVM, approximately 90%

oxygen is delivered with each breath. A BVM should be used in rescue
situations with two or more rescuers.

The mask supplied with a BVM is similar to
that used in a pocket mask. With one hand use the thumb and index finger
to grasp the mask. Place the thumb over the raised portion of the mask.
This visually looks like the letter C. Standing at the victims head, place the
pointed end over the bridge of the victims nose. Place the remaining three
fingers on the victims chin. This visually looks like an E. This technique is
called the EC clamp technique and is the preferred method of using a BVM.
With the second hand attach the bag portion of the device to mask and
squeeze the bag slowly - touching finger to finger to deliver the majority of
the volume of air within the bag device. Upon delivering a breath and seeing
the chest rise, slowly release the bag allowing it to refill while holding the
mask firmly on the victims face. Deliver additional breaths as indicated. Do
not hyperventilate or forcefully squeeze the bag.
BVM's come in Adult, Pediatric, and Neonate sizes - You should use the most
appropriate sized mask/device dependent on patient size.

Checking for a Pulse: Healthcare Providers should
check for a pulse if they feel comfortable before performing chest
compressions on a suspected victim of cardiac arrest. For Adults and
Children, a pulse should be assessed in the carotid artery for 5 to 10
seconds. The carotid artery is assessed due to it being central and likely to

be palpable if a pulses exists. During cardiac compromise the body shunts
circulation to the heart, lungs, and brain as they are most important for
survival of life. Therefore it is possible a carotid pulse may be present while
a peripheral pulse such as the radial may not. In an infant, a brachial pulse
should be assessed as it will be larger and easier to evaluate.
Ratio of Compressions for Infants and Children: Healthcare Providers
should recognize that children likely are hypoxic and are in need of oxygen
during CPR. Therefore, in a healthcare setting with two or more rescuers
present, compressions should performed at the ratio of 15 compressions to 2
breaths instead of the traditional 30:2. By using 15:2, the victim receives
breaths twice as frequent, increasing the overall oxygenation of the patient.
This method is used when multiple rescuers are present to help reduce
fatigue. If alone, use 30:2 until additional rescuers arrive.

Compressions for Infants with two or more
rescuers: Healthcare providers providing CPR to an infant in a healthcare
setting may use an alternative technique to the standard two finger
compression method. The alternative method is called the two thumbs
encircling technique and allows for more effective compressions when
working with another rescuer. The compressing rescuer encircles the infants
body with both hands as in going to pick up the child. The rescuer
compresses the chest while on a hard firm surface with both thumbs. The
second rescuer delivers breaths every 15 compressions. The compressing
rescuer never removes the hands from the victims body while breaths are
being delivered to allow for immediate resumption of compressions.
Advanced Airway: When an advanced airway such as an ET or Combitube is
placed; CPR changes slightly. Compressions are performed at the rate of at
least 100 compressions per minute without interruption and breathing is
performed every 6 seconds (10 times per minute) continually. Compressions
and breaths are performed simultaneously once an advanced airway is in
place.

2010 CPR Guidelines

Rate of Compressions (Adult, Infants,
& Children):

At least 100 compressions per minute.

Depth of Compressions (Adults &
Children):

2 inches / 5 centimeters.

Depth of Compressions (Infants):

1/3 the chest depth.

Ratio of compressions to breaths
(Adults):

30 compressions to 2 rescue breaths.

(Children/Infants):

30 compressions to 2 rescue breaths. (Non
Healthcare or Single Recuer)

(Children/Infants):

15 compressions to 2 rescue breaths. (Healthcare in
Team Rescue)

PUSH HARD / PUSH FAST
Chain of Survival:
Immediate recognition of cardiac arrest and activation of the emergency
response system
Early CPR with an emphasis on chest compressions
Rapid defibrillation (as soon as possible)
Effective advanced life support
Integrated post–cardiac arrest care
Please note that the information contained within in this website reflects
the most recent CPR Guidelines adopted by the International Liaison
Committee on Resuscitation. This website is not affilated with the American
Heart Association. Some content is based upon the clinical experience and
opinion of the author. This website does not construct independent medical
advice or provide medical direction for any situation. This website is not
intended to replace a traditional face to face, hands on, CPR Class with a
qualified CPR Instructor. Click here to find a CPR class in your area. Content
provided for informational and educational purposes only. Linking to this
website, contained content, and images with appropriate credit/citing is
allowed.
Author Information:
This website was created and authored by Matthew Carter (Click to Email).
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Link to this page:
<a href="http://www.cardiopulmonaryresuscitation.net">Cardiopulmonary
Resuscitation (CPR)</a>
Cite this page:
Matthew A. Carter (2013). Cardiopulmonary Resuscitation
(CPR) Retrieved Month Day, Year you visited the website,
from:http://www.cardiopulmonaryresuscitation.net/

Where to get CPR Certification - Find a CPR Class
Last Updated: Saturday, September 21, 2013 1:15
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SITEMAP - Table of Contents:
What is Cardiopulmonary Resuscitation (CPR)?
Cardiopulmonary Resuscitation (CPR) Facts & Statistics
Emergency Situation Considerations
Calling 911
Cardiopulmonary Resuscitation (CPR) for Adults - CPR How To
o Quick Guide of Steps of CPR for Adults
o Scene Assessment / Personal Safety
o Assess the Victim
o Assess Breathing
o Call 911 / Getting Additional Resources
o ABC's of Life - Airway, Breathing, Circulation - Now CAB
o Circulation: Checking For A Pulse
o Circulation: Chest Compressions
 How to Perform Chest Compressions
 How to ensure you perform chest compressions
effectively
o 2 Rescuer Adult CPR
o Airway: Opening the Airway
o Breathing: Rescue Breaths

Breathing: Mouth to Mouth
Breathing: Mouth to Mask
o Breathing: Rescue Breathing without Compressions
Hands Only Cardiopulmonary Resuscitation (CPR)
Compression Only Cardiopulmonary Resuscitation (CPR)
Cardiopulmonary Resuscitation (CPR) for Children - Child CPR How
To
Cardiopulmonary Resuscitation (CPR) for Infants - Infant CPR How
To
o Differences in CPR for Children & Infants
o Defining a child
o Reason for Cardiac Arrest in Children/Infants
o When to Call or Get Help for Children and Infants in Cardiac
Arrest
o Reason for Cardiac Arrest in Children/Infants
o If you are ALONE and FIND an infant or child in cardiac arrest
o If you witness the pediatric victim collapse or have someone
else around
o ABC's of Life for Children (1 to Puberty): CAB - Child CPR How
To
o ABC's of Life for Infants (Birth to Age 1): CAB - Infant CPR How
To
o Quick Guide to Using an AED - How to use an AED
o Special Considerations When Using an AED
Healthcare Provider CPR / Professional Rescuer CPR Considerations
- Basic Life Support
o How to use an BVM
o How to check for a pulse
o Ratio of Compressions for Infants and Children
o Compressions for Infants with two or more rescuers
o Advanced Airways
CPR Guidelines - 2010 AHA CPR Guidelines
o
o

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