TABLE 18-1 Summary of Cardiopulmonary Resuscitation ABCD Guidelines for Infants, Children, and Adults

Maneuver* Adult{ Child{ Infant{

Activate (call) emergencyresponse number (onerescuer)

Call when victim is foundunresponsive

HCP: If asphyxial arrest is likely, callafter five cycles (2 min) of cardio-pulmonary resuscitation (CPR)

Call after performing five cyclesof CPR

For sudden unwitnessedcollapse, call after verifyingthat victim is unresponsive

Call after performing five cyclesof CPR

For sudden unwitnessedcollapse, call after verifying thatvictim is unresponsive

Airway breaths Head tilt–chin lift (HCP: If trauma issuspected, use jaw thrust)

Two effective breaths at 1 sec perbreath

Head tilt–chin lift (HCP: If traumais suspected, use jaw thrust)

Two effective breaths at 1 secper breath

Head tilt–chin lift (HCP: If traumais suspected, use jaw thrust)

Two effective breaths at 1 secper breath

HCP: Rescue breathingwithout chestcompressions

10-12 breaths/min (one breathevery 5-6 sec)

12-20 breaths/min (one breathevery 3-5 sec)

12-20 breaths/min (one breathevery 3-5 sec)

HCP: Rescue breathing forCPR with advancedairway

8-10 breaths/min (one breath every6-8 sec)

8-10 breaths/min (one breathevery 6-8 sec)

8-10 breaths/min (one breathevery 6-8 sec)

Foreign body airwayobstruction

Abdominal thrusts Back slaps and chest thrusts Back slaps and chest thrusts

CIRCULATIONHCP: Pulse check (10 sec or

less)Carotid artery HCP can use femoral artery in

childBrachial or femoral artery

Compression landmarks Center of chest, between nipples Center of chest, between nipples Just below nipple line

Compression method:Push hard and fastAllow complete recoil

Two hands: Heel of one hand, otherhand on top

Two hands: Heel of one handwith second on top or

One hand: Heel of one hand only

One rescuer: two fingersHCP, two rescuers: Two-thumb–

encircling hands technique

Compression depth 1½-2 inches Approximately ⅓ to ½ the depthof the chest

Approximately ⅓ to ½ the depthof the chest

Compression rate Approximately 100 per minute Approximately 100 per minute Approximately 100 per minute

Compression-to-ventilationratio

30:2 (one or two rescuers) 30:2 (single rescuer)HCP: 15:2 (two rescuers)

30:2 (single rescuer)HCP: 15:2 (two rescuers)

DEFIBRILLATIONAutomatic external

defibrillator (AED)Use adult padsDo not use child pads or a child

systemHCP: For out-of-hospital response,

you may provide five cycles(2 min) of CPR before shock ifresponse time is longer than4-5 min and arrest was notwitnessed

HCP: Use AED as soon aspossible for sudden andin-hospital collapse

All: After five cycles of CPR (outof hospital)

Use child pads and system forchild 1-8 yr old if available

If child pads and system are notavailable, use adult AED andpads

No recommendation for infantsyounger than 1 yr old

*Maneuver performed only by health care provider indicated by HCP.{For lay rescuers, adults are defined as those 8 years of age or older; for HCPs, adolescent or older. For lay rescuers, children are those 1 to 8 years of age;for HCPs, 1 year to adolescent.{For all rescuers, infants are defined as those younger than 1 year of age.Reprinted with permission. 2005 American Heart Association Guidelilnes for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Part 3:Overview of CPR. Circulation. 2005;112:IV-12–IV-18. #2005 American Heart Association, Inc.

tBox 18-2 Pyramid Points: When to Stop CPR

Avoid interruptions in cardiopulmonary resuscitation (CPR).Stop CPR only if the following occur(s):Pulse and respiration return.Emergency medical help arrives.The automated external defibrillator is administered.A physician declares the victim deceased.

Additional Pyramid Point: In a non–health care setting, anotherindication to stop CPR is that the lone rescuer was exhaustedand physically unable to continue performing CPR.

tBox 18-1 The ABCDs of CardiopulmonaryResuscitation for the Health Care Provider

A: AirwayB: BreathingC: CirculationD: Defibrillation or definitive treatment

Each step of the ABCDs of cardiopulmonary resuscitationbegins with assessment.