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Learning Objectives
- Recognise when someone’s heart has stopped (cardiac arrest)
- Explain the best way of getting immediate help
- Describe how to do chest compressions (cardiopulmonary resuscitation (CPR))
- Explain what to do if an adult is choking
Lifesaver
A cardiac arrest happens when the heart stops pumping blood around the body. If someone has suddenly collapsed, is not breathing normally and is unresponsive, they may be in cardiac arrest.
It is the ultimate medical emergency with no time to lose. Even if you are untrained, your actions can help the person survive.
CPR stands for cardiopulmonary resuscitation. This can be from basic first aid to the most advanced medical interventions, that can be used to restore the breathing and circulation in someone whose heart and breathing have stopped.
CPR refers to the basic first aid procedures that you can carry out to keep someone alive until the emergency medical services can get to the scene. The most important skills are chest compressions to pump blood around the body and rescue breaths to provide oxygen.
The Resuscitation Council UK has created this interactive resource ‘Lifesaver’ which takes you through different medical emergency scenarios. It explains:
- How to recognise when someone’s heart has stopped
- The best way of getting immediate help
- How to do CPR
- What to do if an adult is choking
Whenever CPR is carried out, particularly on an unknown victim, there is some risk of cross-infection, associated particularly with giving rescue breaths. Normally, this risk is very small and is set against the inevitability that a person in cardiac arrest will die if no assistance is given. The first thing to do is shout for help and dial 999.
Cardiac Arrest and CPR
When the heart stops, the blood supply to the brain also stops. The victim will collapse unconscious and will be unresponsive. Breathing also stops, although it may take a few minutes to stop completely. For the first few minutes the victim may take noisy, infrequent or gasping breaths. The key features of cardiac arrest are therefore someone who is unconscious, unresponsive and not breathing normally. Taking noisy, infrequent or gasping breaths is not normal breathing.
If you have any doubt whether someone is breathing normally or not, assume that it is not normal: call for help immediately and start CPR.
Getting Immediate Help and Giving CPR
A cardiac arrest is an emergency. If you witness a cardiac arrest, you can increase the person’s chances of survival by getting help immediately and giving CPR.
Who Do I Call? You can summon help at the scene using a mobile phone (put it on speaker phone). If it is not possible to telephone for help at the scene, send a bystander to fetch help. If possible, the victim should not be left alone at any stage. Only leave them if there is no other way of obtaining help.
Giving information – When summoning or calling for help you need to be able to give as much accurate information as possible. If you are unsure of the full details or what happened, give as much detail as you can:
- Be clear about the help required: Suspected cardiac arrest
- Be clear about the location: where are you, for example room, floor, building etc
- Ask for a defibrillator, otherwise known as an automated external defibrillator or AED (if an AED is locked and requires a code for access, call 999 for the code)
Stay calm and repeat if necessary.
If the person is not breathing or not breathing normally, you need to give CPR.
Chest compressions
- Kneel next to the person
- Place the heel of one hand in the centreof their chest. Place your other hand on top of the first. Interlock your fingers. You’ll find it easier if you have the hand you write with on top
- With straight arms, use the heel of your hand to push the breastbone down firmly and smoothly, so that the chest is pressed down 5–6 cmand release without removing hands from the chest
- Do this at a rate of 100 to 120 chest compressions per minute – that’s almosttwo per second
- Give 30 chest compressions. You may find it helpful to count out loud
Rescue breaths
If you’d rather not give rescue breaths, then deliver hands-only CPR.
- Open the airway again by tilting the head back and lifting the chin. Pinch the soft part of the person’s nose closed
- Take a normal breath, make a seal around their mouth and breathe out steadily
- The person’s chest should rise. Keeping the person’s head back and the chin lifted, take your mouth away and you should see the patient’s chest fall. Then give a second rescue breath. The two breaths should take no longer than 5 seconds
Repeat 30 chest compressions and two rescue breaths.
Keep going until professional help arrives and takes over, or the person starts to show signs of regaining consciousness, such as coughing, opening their eyes, speaking or breathing normally.
Hands-only CPR is better than doing nothing.
If you are exhausted, instruct someone to continue while you regain energy.
What to do When Someone is Unconscious
If you come across someone who is unconscious, you must do the following:
Check for danger: Approach them with care. Look out for hazards such as fire, traffic and electricity and never put yourself at risk.
Check for a response: Gently shake the person’s shoulders and ask loudly ‘Are you alright?’
Shout for help: If someone is nearby, ask them to stay – you might need them. If you are alone, shout loudly to attract attention but do not leave the person.
Open their airway: Place one hand on the person’s forehead, gently tilt their head back, then lift their chin using two fingers of your other hand under their chin – when you do this you open their airway.
Call for help: If the person is not breathing or not breathing normally, ask someone to call 999 immediately and ask for an ambulance. If alone, call yourself.
Choking
Choking is when the airway gets blocked and a person can’t breathe properly. This prevents oxygen getting into the body. If you think someone is choking, ask them to check they’re not suffering from something else.
Can they speak, cry, cough or breathe? If they can, they should be able to clear their throat on their own by coughing, so encourage them, where possible, to lean forward and cough. If they can’t cough or make any noise, it’s serious.
Cough it out – Encourage them to cough. If this doesn’t clear the obstruction, support their upper body with one hand and help them lean forward.
Slap it out –
- If coughing doesn’t work, help the person bend forward
- Use the heel of your hand to give up to five sharp back blows between their shoulder blades
- Check their mouth to see whether there’s anything in there. If there is, where possible, get them to pick it out
Squeeze it out –
- If back blows don’t work, give up to five abdominal thrusts. Stand behind them
- Link your hands between their tummy button and the bottom of their chest with your lower hand clenched in a fist
- Pull sharply inwards and upwards
Call for help – If they’re still choking, ensure that emergency help is on its way.
What to do next? Once 999 has been called, continue steps 2 and 3 – back blows and abdominal thrusts – until the blockage has cleared, help arrives or they become unresponsive.
If they become unresponsive at any stage, open their airway and check their breathing.
If they’re not breathing, start CPR to try to release whatever’s stuck in there.
Session Summary
Key Points
- If an adult is unresponsive and not breathing, they may be suffering from a cardiac arrest. Without CPR they may die
- Currently less than a third of people who have a cardiac arrest get any CPR before emergency medical help arrives. If you start CPR before help arrives, you can double the person’s chances of survival. Every second counts – any delay can quickly reduce a person’s chance of survival. If they do survive, delay can also cause permanent damage to the person’s brain
- By performing CPR, the aim is to keep their heart and circulation going to try to save their life. With CPR, you are taking over the role of their heart and lungs, pumping blood and oxygen around their body
“If someone has a cardiac arrest, their heart has stopped and they certainly will not survive if no help is offered; you cannot make things any worse! By calling 999 and starting CPR you can only improve their situation.”