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Chapter 4: Adult CPR—Compressions

Before starting Cardiopulmonary Resuscitation (CPR), it’s essential to follow a few quick safety and assessment steps:

  • First, check that the scene is safe. If personal protective equipment (PPE) is available, put it on before approaching the victim.
    • [2021 Interim Guidance] During the COVID-19 pandemic, most lay responders may not have access to proper PPE. To reduce the risk of transmission, use a face mask or cloth to cover your mouth and nose—and the victim’s—while performing CPR.
  • Check if the person is breathing. Tap the person gently and shout, “Are you okay?” If they don’t respond, continue with the next steps.
    • Remember: Gasping or agonal breaths are not considered normal breathing.
  • Call 9-1-1 immediately, or instruct someone nearby to do so. If an Automated External Defibrillator (AED) is nearby, have someone retrieve it. 
  • Check the person’s pulse for no more than 10 seconds. If you’re unsure or unable to detect a pulse, begin CPR immediately.
    • For adults and children, check the carotid artery in the neck. For infants, use the brachial artery on the inside of the upper arm.

Chest Compression Steps for an Adult:

For CPR purposes, anyone who has entered or completed puberty is treated as an adult.

  1. Position yourself beside the victim.
  2. Ensure the person is lying flat on their back on a firm, stable surface.
    1. If the person is face-down and unresponsive, carefully roll them onto their back, supporting the head, neck, and spine.
  3. Quickly remove any clothing covering the chest.
  4. For hand placement:
    1. Place the heel of one hand on the center of the chest, on the lower half of the breastbone (sternum), between the nipples.
    2. Place your other hand on top and interlace the fingers.
    3. Keep your fingers off the chest to avoid applying pressure to the ribs.
  5. To position your body correctly, kneel beside the chest. Keep your arms straight, shoulders directly over your hands, and elbows locked.
  6. Push hard and fast—compress the chest at least 2 inches, but no more than 2.4 inches deep, at a rate of 100 to 120 compressions per minute.
  7. Let the chest fully rise back up after each compression.

When Two Rescuers Are Present:

If a second rescuer is available:

  • Have them activate the Emergency Response System and get the AED.
  • The first rescuer should stay with the victim, uncover the chest, and begin compressions.
  • Once both rescuers are present, alternate compressions approximately every 2 minutes to prevent fatigue.
  • Remind each other to keep compressions between 2 and 2.4 inches deep, and to allow full chest recoil each time.

This chapter in your Online CPR/AED Course walks you through how to begin CPR for an unresponsive adult, using proper technique to increase the chance of survival until help arrives.