How to Perform CPR: Step-by-Step Guide to Cardiopulmonary Resuscitation

In Seattle's Pike Place Market, a 58-year-old man suddenly collapsed while buying flowers for his wife. His heart had stopped – cardiac arrest had struck without warning. A nearby barista immediately began CPR, pumping life through the man's chest for six minutes until paramedics arrived. That coffee shop employee had learned CPR just two months earlier, never imagining she'd use it so soon. Today, that man is alive, celebrating grandchildren's birthdays and anniversary dinners, because someone knew how to perform CPR. Every year, over 350,000 cardiac arrests occur outside hospitals in the United States. Survival rates vary dramatically by location – from 3% in some areas to nearly 50% in communities with widespread CPR training. The difference? Immediate bystander CPR. When someone's heart stops, their brain begins dying within 4 minutes. Paramedics, no matter how fast, often can't arrive in time. But you can be there. You can be the difference. This chapter will teach you exactly how to perform CPR according to the latest 2024-2025 American Heart Association guidelines, with clear, step-by-step instructions that could help you save a life – maybe even someone you love.

Recognizing Cardiac Arrest: Warning Signs That Demand Immediate CPR

Cardiac arrest strikes suddenly and requires immediate recognition. Unlike a heart attack (where the heart still beats but blood flow is blocked), cardiac arrest means the heart has stopped pumping blood entirely. Every second counts, and recognizing the signs quickly can mean the difference between life and death.

Primary Signs of Cardiac Arrest:

1. Sudden collapse – The person falls and cannot be awakened 2. No normal breathing – Absent breathing or only gasping (agonal breathing) 3. No pulse – Though current guidelines emphasize not wasting time checking for layperson rescuers 4. Unconsciousness – No response to shouting or shoulder tapping 5. Color changes – Skin may appear blue, gray, or very pale

Quick Reference Box:

Cardiac Arrest Recognition in 10 Seconds

- Tap shoulders firmly and shout "Are you okay?" - Look for chest movement (normal breathing) - If unresponsive with abnormal/no breathing = START CPR - Don't waste time checking pulse if untrained

Important Note About Agonal Breathing:

Agonal breathing occurs in 40% of cardiac arrest victims and is often mistaken for normal breathing. It appears as: - Irregular, gasping breaths - Snorting or gurgling sounds - Jaw movements without air exchange - Breathing that seems labored or sporadic

Remember: Agonal breathing is NOT effective breathing. Begin CPR immediately.

Certain situations increase cardiac arrest risk: - Previous heart problems - Drowning or near-drowning - Severe trauma - Electrocution - Drug overdose - Severe allergic reactions

However, cardiac arrest can strike anyone, anywhere, without warning. Young athletes collapse on playing fields. Healthy adults suffer sudden cardiac arrest due to undiagnosed conditions. This unpredictability makes widespread CPR knowledge crucial.

Real-Life Scenario:

During a youth soccer game, 16-year-old Marcus suddenly collapsed after heading the ball. His coach recognized the signs immediately – unconsciousness and abnormal breathing. While one parent called 911, the coach began CPR. After 3 minutes of compressions, Marcus gasped and began breathing normally. Doctors later discovered he had an undiagnosed heart condition. The coach's quick recognition and response saved his life.

Step-by-Step CPR Instructions for Adults: The Life-Saving Sequence

Modern CPR has been simplified to encourage more bystanders to act. The 2024-2025 guidelines emphasize "Hands-Only CPR" for untrained rescuers, focusing on chest compressions without mouth-to-mouth breathing. Here's exactly how to perform CPR on adults:

STEP 1: Ensure Scene Safety (5 seconds)

- Check for dangers: traffic, fire, electrical hazards, violence - If unsafe, don't become another victim - Move victim only if absolutely necessary for safety

STEP 2: Check Responsiveness (5-10 seconds)

- Tap shoulders firmly - Shout "Are you okay?" loudly - If responsive but injured, call 911 and provide first aid - If unresponsive, continue to Step 3

STEP 3: Call for Help (30 seconds)

- Call 911 immediately or designate someone specific: "You in the red shirt, call 911!" - Request an AED if available - Put phone on speaker to receive dispatcher guidance - If alone with a phone, use speaker mode while beginning CPR

STEP 4: Position the Victim

- Place on firm, flat surface - If on bed, move to floor if possible - Kneel beside victim's chest - Tilt head back slightly to open airway (if trained)

STEP 5: Correct Hand Position

- Locate the center of chest between nipples - Place heel of one hand on breastbone - Place other hand on top, interlacing fingers - Keep arms straight, shoulders directly over hands

STEP 6: Begin Chest Compressions

Push Hard and Fast:

- Compress at least 2 inches deep (5-6 cm) - Rate of 100-120 compressions per minute - Allow complete chest recoil between compressions - Minimize interruptions (less than 10 seconds)

Compression Technique:

- Use upper body weight, not just arms - Push straight down, not at an angle - Count compressions out loud - Maintain steady rhythm

Practice This Now:

To understand the correct rhythm, compress to the beat of "Stayin' Alive" by the Bee Gees or "Another One Bites the Dust" by Queen – both have the ideal 100-120 beats per minute.

STEP 7: Continue Until Help Arrives

- Don't stop unless: - Person starts breathing normally - AED arrives and prompts you to stop - EMS takes over - Scene becomes unsafe - You become too exhausted to continue effectively

For Trained Rescuers: 30:2 Ratio

If trained in rescue breathing: 1. After 30 compressions, open airway (head-tilt, chin-lift) 2. Give 2 rescue breaths (1 second each) 3. Watch for chest rise 4. Return immediately to compressions 5. Continue 30:2 cycles

DO's and DON'Ts of CPR:

DO:

- Start immediately when cardiac arrest recognized - Push hard and fast - Allow complete chest recoil - Minimize interruptions - Continue until help arrives - Take turns if others can help (switch every 2 minutes)

DON'T:

- Delay starting CPR to check for pulse - Be afraid of pushing too hard - Stop because you're tired (unless completely exhausted) - Give up if person doesn't respond immediately - Move victim unnecessarily - Remove clothing unless using AED

Common CPR Mistakes That Reduce Effectiveness

Even with good intentions, certain mistakes can reduce CPR effectiveness. Understanding these helps ensure your efforts give the victim the best chance of survival:

Mistake #1: Compressions Too Shallow

The most common error is not pushing hard enough. Many people fear hurting the victim, but shallow compressions don't generate blood flow to the brain and heart. - Correct depth: At least 2 inches (5 cm) for adults - Remember: Broken ribs heal; dead brains don't - Tip: Use your body weight, not just arm strength

Mistake #2: Incorrect Hand Position

Placing hands too high, too low, or to the side reduces effectiveness and may cause injury. - Too high: Can break the sternum - Too low: May damage internal organs - Too far to side: Ineffective and may break ribs unnecessarily - Correct position: Center of chest, lower half of breastbone

Mistake #3: Incomplete Chest Recoil

Leaning on the chest between compressions prevents the heart from refilling with blood. - Problem: Reduces blood flow by up to 50% - Solution: Lift hands slightly (maintain contact but no pressure) - Visualization: Think "press-release, press-release"

Mistake #4: Compressions Too Fast or Slow

Rate matters for optimal blood flow. - Too fast (>140/min): Doesn't allow heart filling - Too slow (<80/min): Insufficient blood flow - Target: 100-120 compressions per minute

Mistake #5: Frequent or Long Interruptions

Every interruption stops blood flow to the brain. - Limit pauses to less than 10 seconds - Pre-plan actions to minimize stops - If switching rescuers: Count down "3-2-1-switch"

Mistake #6: Giving Up Too Soon

Many rescuers stop when the person doesn't immediately respond. - Reality: Most victims won't wake up during CPR - Goal: Maintain blood flow until advanced help arrives - Success: May take 20-30 minutes or more

Mistake #7: Rescue Breathing Errors (for trained providers)

- Over-ventilation: Too many breaths reduce blood flow - Under-ventilation: Too few breaths in respiratory arrest - Large breaths: Can cause air in stomach, vomiting

Special CPR Considerations and Variations

While basic CPR principles remain consistent, certain situations require modifications:

CPR for Pregnant Women

- Perform CPR normally with these adjustments: - If visibly pregnant, place rolled towel under right hip - This tilts woman slightly left, improving blood flow - Push harder – you're pumping for two - If trained, prioritize high-quality chest compressions over perfect positioning

CPR for Obese Individuals

- May need to push harder to achieve adequate depth - Ensure firm surface – bed compressions ineffective - Hand position remains the same - Consider kneeling higher for better leverage

CPR in Confined Spaces

- Airplane aisles, cars, bathrooms require adaptation - Get person to firmest surface possible - May need to straddle victim - Modify position but maintain compression quality

CPR on Soft Surfaces

- Beds, couches significantly reduce effectiveness - Move to floor when possible - If cannot move: place board under victim or compensate by pushing harder - Remember: Some CPR better than no CPR

Drowning Victims

- Begin with 2 rescue breaths if trained (exception to compression-first rule) - Water in lungs makes oxygenation critical - Don't waste time trying to drain water - Start compressions after initial breaths

Hypothermia Victims

- Check for signs of life for up to 60 seconds - Perform CPR normally if no signs of life - Continue longer – cold protects the brain - "Not dead until warm and dead"

Trauma Victims

- Maintain spinal alignment if possible - Don't delay CPR for perfect positioning - Control severe bleeding simultaneously if help available - Life over limb principle applies

When to Start and Stop CPR: Critical Decision Points

Knowing when to begin and end CPR involves both medical and ethical considerations:

When to START CPR:

1. Unresponsive + No normal breathing = Begin immediately 2. Unresponsive + Agonal breathing = Begin immediately 3. Drowning victim pulled from water = Begin with rescue breaths if trained 4. Electrocution victim (after ensuring power is off) = Begin immediately 5. Found unconscious, unknown downtime = Begin immediately

When NOT to Start CPR:

1. Obvious signs of death: Rigor mortis, decomposition, decapitation 2. Valid DNR (Do Not Resuscitate) order present 3. Scene unsafe and cannot be made safe 4. Person is conscious or breathing normally

When to STOP CPR:

1. Person starts breathing normally and becomes responsive 2. AED or EMS arrives and takes over 3. Scene becomes unsafe 4. You become too exhausted to continue effectively 5. Obvious signs of death appear (in prolonged attempts)

Important Disclaimer: Never stop CPR just because you think it's not working. Many cardiac arrest survivors received CPR for 30+ minutes before recovery. Continue until professional help arrives or you're physically unable to continue.

Ethical Considerations:

- Start CPR when in doubt – can always stop if DNR found - Family members cannot override your decision to start - Good Samaritan laws protect reasonable attempts - Document time started and any changes observed

Practice Scenarios and Skills Assessment

Regular practice maintains CPR readiness. Use these scenarios to test your knowledge:

Scenario 1: Restaurant Collapse

You're eating dinner when an elderly man at the next table suddenly slumps forward, knocking over his water glass.

Your Actions:

1. Ensure scene safety (no immediate dangers) 2. Tap and shout: "Sir, are you okay?" 3. No response, not breathing normally 4. Point to someone: "Call 911 and get an AED!" 5. Move him to floor with help 6. Begin chest compressions immediately 7. Continue until EMS arrives (8 minutes)

Scenario 2: Home Emergency

Your spouse calls out from the bathroom. You find them unconscious on the floor.

Your Actions:

1. Check responsiveness while calling their name 2. No response, gasping occasionally 3. Call 911 on speaker phone 4. Drag to bedroom floor (more space) 5. Begin compressions while on phone with dispatcher 6. Follow dispatcher instructions 7. Continue CPR until paramedics arrive

Scenario 3: Youth Sports

A teenage basketball player collapses during practice. You're the only adult present with 15 other teens.

Your Actions:

1. Designate specific teen: "Jake, call 911!" 2. Another teen: "Nora, get the AED from the gym wall!" 3. Check athlete – unresponsive, not breathing 4. Begin CPR immediately 5. When AED arrives, follow prompts 6. Resume CPR after shock if indicated 7. Rotate with capable teens if needed

Self-Assessment Questions:

1. What's the correct compression depth for adults? (At least 2 inches) 2. What's the ideal compression rate? (100-120 per minute) 3. Should you check for a pulse before starting? (No, unless trained professional) 4. How long should interruptions be? (Less than 10 seconds) 5. When should you stop CPR? (Only when person breathes normally, help arrives, scene unsafe, or exhausted)

Monthly Practice Routine:

- Week 1: Review hand position and practice on pillow - Week 2: Practice compressions to music (correct rhythm) - Week 3: Run through complete scenario - Week 4: Teach someone else (reinforces your skills)

Frequently Asked Questions About Performing CPR

Q: Will I hurt someone by doing CPR incorrectly?

A: The biggest harm is not doing CPR at all. While broken ribs are possible (and heal), the person is clinically dead without CPR. Your attempts, even if imperfect, can only help. Good Samaritan laws protect those who try to help.

Q: What if I can't remember the exact steps?

A: Remember two things: Call 911 and push hard and fast in the center of the chest. Dispatchers can guide you through the rest. Even compressions alone dramatically improve survival chances.

Q: Should I remove clothing before starting CPR?

A: Don't waste time removing clothing unless using an AED. You can perform effective compressions through normal clothing. Remove only if clothing prevents proper hand placement or AED pad attachment.

Q: What if the person vomits during CPR?

A: This occurs in about 30% of cases. Quickly turn their head to the side, clear visible vomit with your fingers or cloth, return head to normal position, and resume compressions. Don't delay more than 10 seconds.

Q: How do I know if CPR is working?

A: You may not see immediate signs. Sometimes you'll feel resistance change, see color improve, or notice occasional gasps. But often there's no obvious sign until professional help arrives. Keep going – you're buying time for advanced care.

Q: Can I perform CPR on someone with a pacemaker?

A: Yes. You may feel a small hard lump under the skin (usually below left collarbone). Perform CPR normally, but if using an AED, place pads at least 1 inch away from the device.

Q: What if I get tired?

A: CPR is exhausting. If others are present, switch every 2 minutes. If alone, continue as best you can. Even compressions that become less effective are better than stopping. Call out for help – others may arrive.

Q: Should I practice on real people?

A: Never practice full force on conscious people. Use mannequins in classes or practice hand position and rhythm gently on family members. Pillows can help practice rhythm and approximate resistance.

Q: Is mouth-to-mouth still recommended?

A: For untrained bystanders, hands-only CPR is recommended for adults. It's simpler and people are more willing to act. Trained responders should still provide rescue breaths, especially for children and drowning victims.

Q: What's different about CPR in 2024-2025?

A: Latest guidelines emphasize: - Earlier recognition of cardiac arrest - Immediate compressions for untrained bystanders - Minimizing interruptions - Team-based approach when possible - Integration with technology (dispatcher-assisted CPR) - Focus on compression quality over perfect technique

Learning CPR transforms you from a helpless bystander into someone who can literally save lives. Every compression you perform pushes oxygen-rich blood to dying brain cells. Every minute of CPR doubles or triples survival chances. The person whose life you save might be a stranger in a restaurant, a coworker at your office, or someone you love dearly at home.

The skills in this chapter require no special strength or medical knowledge – just the willingness to act when seconds count. Practice regularly, maintain your confidence, and remember that any attempt at CPR is better than standing by helplessly. You now possess knowledge that fewer than 40% of Americans have, despite its life-saving potential.

Keep this chapter handy, review it monthly, and share this knowledge with others. Every person trained in CPR creates a safer community for all of us. The next time you hear about a cardiac arrest save, remember – that could be you making the difference between a tragedy and a miracle.# Chapter 3: Heimlich Maneuver: How to Save Someone from Choking in Seconds

Every year, approximately 5,000 people die from choking in the United States alone, making it the fourth leading cause of unintentional injury death. In a bustling restaurant in Manhattan, Nora watched in horror as her colleague suddenly clutched his throat during a business lunch. His face turned red, then purple, as he struggled to breathe. The universal choking sign—both hands clutching the throat—told everyone what was happening, but most diners froze in panic. Fortunately, a trained server recognized the emergency and performed the Heimlich maneuver, dislodging a piece of steak within 30 seconds. This life-saving technique, developed by Dr. Henry Heimlich in 1974, has saved countless lives and can be learned by anyone. When someone's airway becomes blocked, you have mere minutes to act before brain damage or death occurs. Understanding how to properly perform the Heimlich maneuver could mean the difference between being a helpless bystander and saving a life.