16 CPR

Mouth to mouth

Kneel beside the patient's head. Maintain an open airway.

Take a breath, open your mouth as wide as possible and place it over the patient's slightly open mouth. Whilst maintaining an open airway seal the patient's nostrils with first aider's cheek (or pinch patient's nose) and blow to inflate the patient's lungs. Because the hand supporting the head sometimes comes forward some head tilt may be lost and the airway may be obstructed. Pulling upwards with the hand on the chin helps to reduce the lost head tilt.

For mouth to mouth breaths, it is reasonable to give each breath in a short time with a volume to achieve chest rise regardless of the cause of cardiac arrest. Care should be taken not to over – inflate the chest.

Look for rise of the patient's chest during each inflation. If the chest does not rise, possible causes are:

  • Obstruction in the airway (inadequate head tilt, jaw thrust, tongue or foreign material);
  • Insufficient air being blown into lungs;
  • Inadequate air seal around mouth and/or nose.

If the chest does not rise, ensure correct head tilt, adequate air seal and ventilation. Following inflation of the lungs, lift your mouth from patient's mouth, turn your head towards the patient's chest and listen and feel for is being exhausted from the mouth and nose.

CPR risk

No human studies have addressed the safety, effectiveness, or feasibility of using barriers devices to prevent patient contact during first aider breathing. The risk of disease transmission is very low and initiating breathing without barrier device is reasonable. If available, first aiders should consider using a barrier device. It is recommended to use a CPR protective shield (barrier device). These can be purchased for most chemists and first aid suppliers.

Chest compressions

Recognition of the need for Chest Compressions

First aiders should perform chest compressions for all patients who are unresponsive and not breathing normally.

First aiders should use unresponsiveness and absence of normal breathing to identify the need for CPR. Checking for a pulse is unreliable and should not be performed to confirm the need for CPR.

Locating the site for chest compressions.

There is insufficient evidence for or against a specific hand position for chest compressions during CPR. For a patient receiving chest compressions, place your hands on the lower half on sternum. First aider should place the heel of their hand in the centre of the chest with the other hand on top. (The first aider should either link their thumb around the wrist of lower hand or link the fingers together, to stop the top hand slipping). Avoid compression beyond the lower limit of the sternum. Compression applied too high is ineffective and, if applied too low may cause regurgitation and/or damage to internal organs.

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