Steps of CPR

Why This Matters

CPR is the ultimate high-stakes skill in first aid—you're literally keeping someone alive by manually circulating oxygenated blood to their brain and vital organs. The exam will test you not just on the sequence of steps, but on why each step matters physiologically: how compressions create artificial circulation, why timing and depth are critical, and how the chain of survival connects bystander response to professional care.

Don't just memorize "30 compressions, 2 breaths." Understand that every step builds on the previous one—scene safety protects the rescuer, early recognition triggers the response, quality compressions buy time, and early defibrillation addresses the most common cause of cardiac arrest. Know what each step accomplishes and you'll handle any scenario the exam throws at you.

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Scene Assessment and Activation

Before touching a victim, you must ensure the scene won't create a second patient—you. These initial steps also activate the emergency response system, which is critical because CPR alone rarely restores a heartbeat. Professional intervention with advanced cardiac life support is the ultimate goal.

Check the Scene for Safety

• Scene safety comes first—scan for hazards like traffic, fire, downed electrical wires, or toxic environments before approaching
• "If the scene is not safe, do not enter" is a core principle; a dead or injured rescuer helps no one
• Dynamic hazards require ongoing reassessment throughout the rescue attempt

Check for Responsiveness

• Tap and shout method—firmly tap the shoulders and loudly ask "Are you okay?" to assess consciousness
• AVPU scale (Alert, Verbal response, Pain response, Unresponsive) helps categorize the victim's level of consciousness
• No response within 5-10 seconds indicates you should immediately move to activating emergency services

Call for Help

• Early activation of EMS is a critical link in the chain of survival—call 911 (or direct a bystander to call) before starting compressions if alone with an adult
• Speaker mode allows you to receive dispatcher instructions while beginning CPR
• Location and condition—clearly state your address and that the person is unresponsive and not breathing normally

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Assessment and Airway

Once you've confirmed an unresponsive victim and activated EMS, you need to determine if CPR is necessary. Cardiac arrest presents as absent or abnormal breathing (agonal gasps), which triggers the decision to begin compressions.

Check for Breathing

• Look, listen, feel for no more than 10 seconds—observe chest rise, listen for breath sounds, feel for air on your cheek
• Agonal gasps (irregular, gasping breaths) are NOT normal breathing and indicate cardiac arrest—begin CPR immediately
• "When in doubt, start CPR"—the risk of not acting far outweighs the minimal risk of compressions on someone who doesn't need them

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Circulation: Chest Compressions

Compressions are the engine of CPR. By manually compressing the heart between the sternum and spine, you create artificial circulation that delivers oxygenated blood to the brain and vital organs. Quality matters enormously here—poor compressions mean poor outcomes.

Begin Chest Compressions

• Hand placement—heel of one hand on the center of the chest (lower half of sternum), other hand on top with fingers interlocked
• Rate of 100-120 compressions per minute—think of the beat to "Stayin' Alive" by the Bee Gees as a rhythm guide
• Depth of at least 2 inches (5 cm) in adults with full chest recoil between compressions; leaning prevents the heart from refilling

Continue CPR Cycles

• 30:2 ratio—30 compressions followed by 2 rescue breaths is the standard cycle for single-rescuer CPR
• Minimize interruptions—pauses in compressions should be under 10 seconds; every second without compressions means no blood flow
• Rescuer fatigue degrades compression quality after about 2 minutes; switch rescuers if possible while minimizing pause time

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Ventilation: Rescue Breaths

Rescue breaths deliver oxygen to the lungs, which then gets circulated by your compressions. The head-tilt, chin-lift maneuver opens the airway by lifting the tongue off the back of the throat.

Give Rescue Breaths

• Head-tilt, chin-lift—tilt the head back with one hand on the forehead, lift the chin with fingers under the bony part (not soft tissue)
• Seal and deliver—pinch the nose, create a complete seal over the mouth, and give 2 breaths lasting about 1 second each
• Watch for chest rise—visible chest rise confirms air is entering the lungs; if no rise, reposition the airway and try again

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Defibrillation and Continuation

An AED can deliver an electrical shock to restore a normal heart rhythm in cases of ventricular fibrillation or pulseless ventricular tachycardia—the most common initial rhythms in witnessed cardiac arrest. Early defibrillation dramatically improves survival.

Use an AED if Available

• Turn on and follow prompts—AEDs are designed for untrained users; the device analyzes the rhythm and advises whether a shock is needed
• Pad placement—one pad on the upper right chest (below the clavicle), one on the lower left side (below the armpit); ensure pads don't touch
• "Clear" before shock—ensure no one is touching the victim during analysis and shock delivery to prevent injury to rescuers

Continue CPR Until Help Arrives

• Do not stop unless EMS takes over, the victim shows obvious signs of life (movement, normal breathing), or you become physically unable
• Signs of life include spontaneous movement, normal breathing, or coughing—if these appear, place the victim in the recovery position and monitor
• Chain of survival completes when advanced care arrives; your role is to bridge the gap with high-quality CPR

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Quick Reference Table

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Self-Check Questions

1. What two assessments must you complete before beginning chest compressions, and what findings would prompt you to start CPR?

2. Compare the goals of chest compressions versus AED use—what problem does each intervention address?

3. A victim is making occasional gasping sounds but is unresponsive. Should you begin CPR? Explain your reasoning using the correct terminology.

4. What three elements define high-quality chest compressions, and what happens physiologically if any element is inadequate?

5. Compare the indications for hands-only CPR versus conventional 30:2 CPR—when is each approach appropriate, and why?