CPR (cardiopulmonary resuscitation) is the basic lifesaving technique used when someone stops breathing and/or his heart no longer beats. In children, if CPR is needed, it is most often for breathing problems due to choking, smoke inhalation, lung disease such as asthma, drowning or other accidents (not for heart problems as in adults). CPR is most successful when started as quickly as possible, but only when it's necessary. It should only be performed when a person is not breathing or circulating blood adequately.
It is ideal for everyone to know how to perform CPR. To enroll in a CPR course, contact your local office of the American Red Cross or American Heart Association. While this can not take the place of a CPR course, here is an overview of the basic steps in performing CPR on a child older than 8 years old or on an adult (For a child between the ages of 1 and 8 years old, see Administering CPR to a Child; for a child younger than 1 year, see Administering CPR to an Infant):
• Assess and get help.
The first few seconds should be used to figure out whether the child is truly unresponsive. To do this, call out the child's name, clap, gently tap his shoulder, or rub his back or chest and watch for any reaction. If you get no response, call 911 or your local emergency number immediately. Return to the victim as soon as possible. If you are not alone, have someone else dial 911, while you take care of the victim.
• Position the child or adult.
Place the child on his back on a hard, flat surface such as the floor or a table. If the child may have injured himself, be careful when moving him and always support the head and neck.
• Compress the chest.
Place the heel of one hand on the lower half of the breastbone, about two finger widths above the notch at the lower end of the breastbone (where the ribs meet the breastbone). Place your other hand directly on top of it. Push in a downward motion toward the child's back approximately one-third to one-half the depth of the chest (about 2 or more inches). You should do compressions at a rate of at least 100 per minute (or about five compressions every three seconds) in a smooth and on-going fashion. After giving 30 compressions, reposition the airway and give the child two rescue breaths.
• Open the airway.
Place one hand on the child's forehead and the other under his chin. Slightly tilt the child's head back to open the airway by lifting the chin up and out while pushing down on the forehead.
• Check for breathing.
Turn your head toward the child's chest. Look for chest movement. Place your ear and cheek over the child's mouth to listen or feel for any signs of breathing. Watch for any chest-wall movement. If you can see, hear or feel the child breathing, help him to maintain an open airway, but do not start breathing for him (rescue breathing). If the child is not breathing, immediately begin rescue breathing.
• Perform rescue breathing.
If the child is not breathing, pinch the child's nostrils closed with your thumb and forefinger while keeping pressure on the child's forehead with the same hand. Lift the chin with the other hand and keep the head tilted slightly. Take a deep breath and then place your mouth over the child's mouth, making a tight seal. Give two slow breaths (each about 1 second long). Watch for the child's chest to rise with each breath, and end the breath once you see the chest rise. If the chest does not rise, re-position the head to make sure the child's airway is open, and again try to give a second breath. If the chest still does not rise, the child may be choking.
• Repeat 30 compressions and two breaths.
Give two rescue breaths after every 30 chest compressions. Count out loud as you do this, "One, and two, and three ... and 30, breathe." Do a total of five cycles of 30 chest compressions and two rescue breaths, which should take about two minutes.
• Check for return of breathing or signs of circulation.
Every few minutes or so, recheck for signs of circulation (for example, normal breathing, coughing or movement) and breathing. If there are no signs of circulation, continue and repeat with 30 chest compressions and 2 rescue breaths.
If there are signs of circulation, but there is no breathing, continue rescue breathing with one breath every three seconds (20 breaths per minute). Continue to regularly check the breathing and circulation until emergency personnel arrive.
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