If the victim hasn' t started to breathe, close his nostrils with the thumb and index finger of your hand on his forehead.
Open your mouth wide and place it over the victim' s mouth, sealing it tightly so that no air can escape.
When you use the jaw-thrust method to open the airway, you must tuck your cheek under his nostrils.
Deliver four quick breaths
o Don' t allow the victim to exhale between these breaths.
o These four breaths maintain positive pressure in the airway. Even if the victim has stopped breathing for only for a short time, some of his lungs' alveoli may have collapsed. Positive pressure helps reinflate them.
When you see the victim' s chest rise, then fall (after your fourth breath), you will know that air is entering and escaping his lungs. If the victim wears dentures, keeping them in place will usually make ventilation easier. But if they are slipping, remove them.
Now locate the victim' s carotid pulse. To do so, keep your hand on his forehead to maintain the head-tilt position. Use your other hand to find the carotid artery on the side closest to you, in the groove beside the larynx. Use your index and middle fingers to gently palpate the artery for 5 to 10 seconds.
If you find a pulse, don' t give cardiac compressions but do ventilate the patient at a rate of one breath every seconds (12 breaths a minute).
Continue to check his pulse after every 12 breaths. If you find no pulse, prepare to begin cardiac compression. Position yourself close to the victim' s side, with your knees apart. This position gives you a broad base of support.
Use the fingers of your hand that' s closest to the victim' s feet to lower margin of his rib cage and trace the margin to the notch where the ribs meet the sternum.
Next, place your middle finger on the notch.
Place your index finger of the same hand next to your middle finger. Then place the heel of your other hand next to your index finger on the long axis of the sternum, as shown.
This is the correct position for cardiac compression. If your hands are placed incorrectly, you may lacerate the victim' s liver or fracture a rib.
Place the hand you used to locate the notch over the heel of your other hand. Interlock or extend your fingers to keep them off the victim' s ribs and to maintain vertical pressure through the heel of the hand touching the sternum.
Align your shoulders over your hands, keeping your elbows straight. Keeping your fingers off the ribs and your shoulders aligned ensures that you will compress downward, not laterally. Lateral compressions won' t deliver sufficient pressure.
Using the weight of your upper body, compress downward about 1.1/2 to 2 inches (3 to 5 cm), concentrating the pressure through the heels of your hands.
Don' t deliver bouncing compressions because they are less effective and could injure the victim. Then relax the pressure completely to let the victim' s heart fill with blood.
Don' t remove your hands from his chest when you relax, or you will lose your hand position.
If you are the only rescuer, time your compressions at a rate of 80 a minute. Count, 'One and two and three and four and five and …' up to the count of fifteen.
Then deliver two quick breaths without allowing the victim to exhale between them. (Actually, you will be delivering 60 compressions a minute, with the delay to
ventilate the victim).
Perform CPR for 1 minute, check the victim' s pulse, then quickly telephone for help if none has arrived. Return quickly and resume CPR. If there is no phone available, continue CPR.
If a second rescuer arrives, ask her to call or go for help if you have not been able to do so. Then she can help you resuscitate the victim. (Of course, she must be trained in CPR if she is going to assist you).
Have the second rescuer get on the opposite side of the victim' s airway, across from you. As she opens the victim' s airway and tries to locate the carotid pulse, you continue giving compressions.
If your compressions are strong enough, she should feel a pulse. When the second rescuer signal that she has found the pulse you are generating, stop your compressions for 5 seconds so she can see if the victim' s heart is beating on its own.
If she can' t feel a spontaneous pulse, she should deliver one breathe. You can then resume compressions (approximately 60 per minute), while the second rescuer delivers a full breath on the upstroke of every fifth compression.
To assure that you work as a team, count out loud: 'One thousand one, one thousand two, one thousand three, one thousand four, one thousand five, one thousand…' and so on. Have the second rescuer check for the victim' s pulse every few minutes.
When you feel tired, tell the second rescuer you want to switch positions. To alert her, say: 'Switch, one thousand, two, one thousand, five, one thousand'. When you finish this count, the second rescuer should be delivering a full breath as you a move toward the victim' s head.
When you get to his head, open his airway and assess his carotid pulse for 5 seconds. The second rescuer should get into position for cardiac compression.
If you can' t feel a pulse, deliver one breath and tell the second rescuer to start the compressions. If you do find a pulse but the victim is not breathing, tell the second rescuer not to give any compression.
Continue giving the victim mouth-mouth ventilation and check his pulse every few minutes, in case his heart stops again.