CPR, AED and First Aid Series

CPR in Infants

Victoria Vetter, MD, FAAP, FACC: Hello. My name is Dr. Victoria Vetter and I'm a pediatric cardiologist and the Director of Youth Heart Watch at the Children's Hospital of Philadelphia. This video will demonstrate how to perform CPR and use an AED on an infant from birth to one year of age when a sudden cardiac arrest occurs. CPR stands for cardio pulmonary resuscitation, which is done by pushing hard and fast in the center of the chest.

CPR helps to manually push blood through a person's body when their heart has stopped beating. An automated external defibrillator, or AED, is a device that reads or analyzes a person's heart rhythm. When needed, it can shock or reset the heart to a normal rhythm. Prompt CPR and use of an AED can help save a baby's life before emergency medical services arrive.

CPR should be performed when someone is unresponsive, not breathing, or not breathing normally with gasping or agonal breathing. Check for responsiveness. If an infant is unresponsive, check the infant by gently tapping the bottom of the baby's feet or shoulders and shouting, "Baby, baby. Are you okay?" Call 911.

Woman: 911? My baby's not responding. I need help.

Victoria Vetter, MD, FAAP, FACC: If you are alone, put your phone on speaker. Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended

For healthcare providers, check for breathing and a pulse. Pulse on an infant should be checked in the inside of the upper arm between the shoulder and the elbow -- the brachial pulse. If the infant is not breathing begin CPR. If the infant is breathing and has a strong pulse, wait for EMS to arrive.

Rate and depth of compressions. Lay the infant on their back on a hard, flat surface and use your index and middle fingers to press down in the center of the chest just below the nipple line.

Press down at a rate of 100 to 120 beats per minute, making sure you're reaching a depth of about one and a half inches -- about one third the depth of the chest for -- 30 times. You should count out loud.

Woman: 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30.

Victoria Vetter, MD, FAAP, FACC: Make sure you are not leaning on the chest and you're allowing the chest to recoil or expand completely after each compression. Follow the 30 compressions with two gentle rescue breaths.

Compression ventilation ratio and airway. Tilt the infant's head back by lifting the chin, cover both the nose and mouth with your mouth and give two breaths. Be careful not to overextend the neck. You will see the infant's chest rise and fall.

Continue the cycle of 30 compressions to two breaths until the infant is responsive or emergency medical services arrive. Infant CPR will look like this for a single rescuer.

If there are two rescuers, one can perform CPR using a two-thumb encircling hand position around the chest that looks like this. With two rescuers for an infant, the ratio of compressions to breath is 15 to 2.

Man: 8, 9, 10, 11, 12, 13, 14, 15.

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15.

Victoria Vetter, MD, FAAP, FACC: AED use. If you are in an area where an AED is present or can be retrieved within a few minutes, tell someone to get the AED while you begin CPR.

Woman: Molly's not breathing. I'd call 911. We need the AED.

Man: Ok.

Victoria Vetter, MD, FAAP, FACC: If you are alone and witness the arrest, retrieve the AED immediately, turn it on and follow the voice instructions.

If you are alone and did not witness the arrest, begin CPR immediately and pause to retrieve the AED after two minutes of chest compressions and breaths.

Using an AED is quite simple. Although every AED is slightly different, they are all made to be user friendly, and walk you through the steps. After the AED is on the scene, open the unit and turn it on. Then following the images or instructions, put the pediatric pads on the infant, placing one on the front of the chest and the other on the back.

If the AED only has adult pads, they can still be used and placed in the same positions, front and back of the chest. Continue CPR until the AED tells you to stop while it is analyzing the heart rhythm. If a shock is advised, the AED will tell you to stand clear and either press the shock button or shock will be automatically delivered by the unit.

Begin CPR again after the shock. If a shock is not advised, unit will tell you to continue chest compressions. Continue CPR and follow the AED voice instructions until EMS arrives or until the infant regains consciousness.

Man: 6, 7, 8, 9, 10, 11, 12, 13, 14, 15.

Victoria Vetter, MD, FAAP, FACC: Do not remove the pads from the infant because they might suffer another cardiac arrest before help arrives and need to be shocked again.

Let's review the steps of infant CPR and AED use. First, assess the scene and check for responsiveness. Next, call 911 and have someone get an AED if available. Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended. For healthcare providers, check for breathing and a pulse.

Begin CPR by using two fingers to press hard and fast in the center of the chest for 30 compressions. After 30 compressions, give two rescue breaths and repeat this sequence of 30 compressions to two rescue breaths. If two rescuers are present, the ratio is 15 compressions to two breaths. If an AED is available, place the pads in the front and back of the chest and follow the instructions from the unit.

Continue CPR and rescue breaths until EMS arrives.

CPR in Adults

Victoria Vetter, MD, FAAP, FACC: Hello, my name is Dr. Victoria Vetter and I'm a pediatric cardiologist and the Director of Youth Heart Watch at the Children's Hospital of Philadelphia. This video will demonstrate how to perform CPR and use an AED on an adult when a sudden cardiac arrest occurs. CPR stands for cardiopulmonary resuscitation and is done by pushing hard and fast in the center of the chest.

CPR helps to manually push blood through a person's body when their heart has stopped beating.

An automated external defibrillator or AED is a device that reads a person's heart rhythm and can shock or reset the heart to a normal rhythm. Prompt CPR and use of an AED can help save a person's life before EMS arrives.

CPR should be performed when someone is unresponsive, not breathing or not breathing normally, with gasping or agonal breathing.

Scene safety. First, if an adult is unresponsive and you suspect a cardiac arrest, assess the scene.

Man: Are you okay?

Victoria Vetter, MD, FAAP, FACC: Check for responsiveness. When you know you are safe, tap the victim and shout to check their responsiveness.

Man: Are you okay?

Victoria Vetter, MD, FAAP, FACC: Alert EMS. Call 911. If the person is unresponsive, tell someone to call 911 and retrieve an AED immediately if one is available. If you are alone, call 911 yourself and get the AED. If you are alone and then AED is unavailable, put the phone on speaker so you have two hands to help the victim.

Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended.

For healthcare providers, check for breathing and a pulse. Check in the neck for the carotid pulse and check to see if they are breathing. If the person is not breathing, or not breathing normally or gasping for breath, begin CPR. You'll want to make sure the person is face up on a hard flat surface. If they are on a bed or other cushioned area, you should move them to the floor.

Begin hands-only or compression-only CPR. Put the heel of one hand over the lower end of the breast bone in the center of the chest at the nipple line. Cover with your other hand and interlock your fingers. Straighten your arms and lock your elbows so that your body weight is over your hands. Push straight down at a rate of 100 to 120 beats per minute at a depth of two inches, about one third the depth of the chest.

Make sure you are not leaning on the chest and you're allowing the chest to recoil or expand completely after each compression. Count out loud when doing the compressions, it should look and sound like this.

Man: 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30.

Victoria Vetter, MD, FAAP, FACC: AED use. Using an AED is quite simple. Although every AED is slightly different, they are all made to be user-friendly and walk you through the steps. Once the AED is on the scene, you will open the unit, turn it on, and immediately begin attaching it to the victim. Then following the images or instructions, put the pads on the victim's bare chest, placing one over the right side of the victim's chest, just below the collarbone. And the other on the lower left side of the chest.

The pads are placed in these positions to deliver a shock across the heart. If the victim has a pacemaker, implantable cardiac defibrillator or medical patch that you can see, avoid placing the pads directly over these items. If there is hair on the chest in the area of the pad placement, it will need to be quickly shaved with a razor in the safety kit attached to the AED.

Continue CPR until the AED tells you to stop while it analyzes the heart rhythm.

AED: Do not touch patient. Analyzing rhythm.

Victoria Vetter, MD, FAAP, FACC: If a shock is advised, the AED will tell you to stand clear and either press the shock button or shock will be automatically delivered by the unit, and you'll begin CPR again. If a shock is not advised, the unit will tell you to continue chest compressions.

Continue CPR and following the AED voice instructions until EMS arrives or until the victim regains consciousness. Do not remove the pads from the victim because they might suffer another arrest before help arrives and need to be shocked again.

Compression breath ratio. If the victim is a drowning victim, you will need to provide rescue breaths.

Perform 30 compressions, followed by two breaths, and repeat this cycle.

Let's review the steps of adult CPR and AED use again. First, assess the scene and check for responsiveness. Next, call 911 and get an AED if available. Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended. For healthcare providers, check for breathing and if they have a pulse.

If not, begin hands-only CPR and use the AED once it arrives. Continue CPR and follow AED instructions until EMS arrives.

CPR in Children

Victoria Vetter, MD, FAAP, FACC: Hello, my name is Dr. Victoria Vetter and I'm a pediatric cardiologist and the Director of Youth Heart Watch at the Children's Hospital of Philadelphia. This video will demonstrate how to perform CPR and use an AED on a child from the age of one year to puberty or approximately 12 years of age.

CPR stands for cardiopulmonary resuscitation and is performed by pushing hard and fast in the center of the chest. CPR helps to manually push blood through a person's body when their heart has stopped beating.

An automated external defibrillator, or AED, is a device that reads a person's heart rhythm and can shock or reset the heart to a normal rhythm. Prompt CPR and use of an AED can help save a child's life before emergency medical services arrive.

CPR should be performed when someone is unresponsive, not breathing or not breathing normally, with a gasping or agonal breathing. If a child appears unresponsive, check the child by gently shaking them and shouting, "Hey, hey, are you okay?"

Man: Jimmy, can you hear me?

Victoria Vetter, MD, FAAP, FACC: If they do not respond and are not breathing, have someone call 911 and get an AED immediately.

Man: 911? My child has collapsed. I need help.

Victoria Vetter, MD, FAAP, FACC: If you are alone and witness a collapse, activate 911 and get an AEG yourself, if available, before performing CPR. If you are alone and the collapse was not witnessed, call 911 and put them on speaker phone. If you do not have a cell phone nearby and need to choose between calling for help and starting CPR, start CPR immediately.

Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended

For healthcare providers, check for breathing and a pulse. Check in the neck for the carotid pulse for no more than 10 seconds. Remove any clothing on the upper body and begin CPR. To begin CPR, lay the child on their back on a flat surface and place one hand over the other, in the center of the chest on the breast bone, just below the nipple line.

Rate and depth of compressions. Put the heel of one hand over the lower end of the breast bone in the center of the chest at the nipple line. Cover with your other hand and interlock your fingers. Straighten your arms and lock your elbows so that your body weight is over your hands. Push straight down at a rate of 100 to 120 beats per minute at a depth of two inches, about one third the depth of the chest.

Count out loud when doing the compressions. Make sure you are not leaning on the chest and that you're allowing the chest to recoil or expand completely after each compression.

Compression breath ratio. For a child, after you give 30 compressions, you should follow the compressions with two rescue breaths. Tilt the child's head back by lifting the chin up, plugging the nose, and giving two breaths. You will see the child's chest rise and fall. Continue the cycle of 30 compressions to two breaths until the child is responsive, our emergency medical services arrive. Compressions on a child with rescue breaths should look like this.

After puberty, witnessed arrest, not related to drowning or respiratory problems such as asthma, may be treated with compression-only CPR.

AED use. Although every AED is slightly different, they are all made to be user-friendly and walk you through the steps. After the AED is on the scene, you will need to open the unit and turn it on. This may happen simply by opening it up or by pushing the on button. Then following the image or voice instructions, put the pediatric pads on the child placing, one on the front of the chest and the other on the back.

If the unit only has adult electrode pads, they are safe to use on a child. Continue CPR until the AED tells you to stop, while it is analyzing the heart rhythm.

AED: Do not touch patient. Analyzing rhythm.

Victoria Vetter, MD, FAAP, FACC: If a shock is advised, the AED will tell you to stand clear and either press the shock button or shock will be automatically delivered by the unit, and you will immediately begin CPR again.

If a shock is not advised, the unit will tell you to continue chest compressions.

After about five cycles, the AED will analyze the rhythm and advise a shock, if needed. Continue CPR in following the AED voice instructions until EMS arrives or until the child regains consciousness.

Do not remove the pads from the child because they might suffer another cardiac arrest before help arrives and need to be shocked again.

Let's review the steps of child CPR and AED use. First, assess the scene and check for responsiveness. Next, call 911 and have someone get an AED. Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended. For healthcare providers, check for breathing and a pulse.

Begin CPR by pushing hard and fast in the center of the chest 30 times. After 30 compressions, give two rescue breaths and repeat this CPR cycle. If an AED is available, follow the instructions from the unit.

How to Use an AED on All Ages

Victoria Vetter, MD, FAAP, FACC: Hello, I'm Dr. Victoria Vetter. I'm a pediatric cardiologist and the Medical Director of Youth Heart Watch at the Children's Hospital of Philadelphia. This video will demonstrate the use of an AED in conjunction with CPR to help save lives from sudden cardiac arrest. An AED is an important step in the chain of survival because it can analyze or read the heart's rhythm.

And when appropriate, deliver a shock to restart or reset a heart's electrical signal and save someone's life.

AED stands for automated external defibrillator. It is important to know how to use an AED because a victim's chance of survival decreases by 10% every minute after a sudden cardiac arrest. You can help save a life by retrieving and using an AED before EMS arrives.

Anyone can use an AED. It's quite easy to use and cannot harm the victim.

Adult AED use. Assess victim and get AED. If an adult collapses or is found unresponsive, have someone call 911 and get an AED immediately if one is available while you begin CPR. If you are alone, call 911 and retrieve an AED before beginning CPR.

Follow AED prompts. Once the AED is on site, open the unit and turn it on if needed. The unit will give you verbal instructions to follow

AED: Tear open package and remove pads.

Victoria Vetter, MD, FAAP, FACC: If you have help on site, continue CPR while the AED is being set up. Plug the electrode cable attached to the pads into the unit if they are not already connected.

Electrode pad placement. You should then open the electrode pads and place them on the victim's bare chest as shown on the pad pictures. One over the victim's right chest, just below the collarbone and the other on the left side of the victim's chest. Below the left nipple.

AED: Place one pad on bare upper. Chest peel, second pad and place on bare lower chest as shown.

Victoria Vetter, MD, FAAP, FACC: The position is to allow the shock to discharge across the heart.

Rhythm analysis and shock delivery. The unit will analyze the heart's rhythm and tell you to stop compressions. If a shock is advised, tell all to stand clear of the victim and not to touch anything.

AED: Do not touch patient. Analyzing rhythm.

Victoria Vetter, MD, FAAP, FACC: Allow the AED to assess the rhythm and advise shock delivery or not.

The unit will tell you if you will have to push the shock button.

AED: Shock advised.

Victoria Vetter, MD, FAAP, FACC: Or if it will automatically deliver a shock.

Continue CPR. After the shock is delivered, resume CPR until the unit analyzes again. If a shock is not advised, continue compressions. Continue this cycle until the victim is responsive or until EMS arrives.

If the victim wakes up, do not remove the pads from their chest. It is not uncommon for another arrest to occur with a need for another shock.

AED use -- child and infant. Assess victim and get AED. Using an AED on a child or infant is very similar to an adult. If you witness a child collapse and they are unresponsive and not breathing, call 911 and retrieve an available AED immediately while someone begins CPR. If you are alone and find the child is on the ground without witnessing the arrest, call 911 on a speaker phone and begin CPR.

Perform two minutes of chest compressions and rescue breasts before you leave to retrieve an available AED.

Follow AED prompts. Once the AED is on scene, open the unit, turn it on if needed, and plug in the child or pediatric pads if available.

Electrode pad placement. If the unit only has adult electrode pads, they are safe to use on a child. Place one pad in the center of the child or infant's chest, and one on the center of the back of the chest.

Rhythm analysis shock delivery. Lay the child flat on their back and resume CPR until the AED tells you it is analyzing the heart's rhythm. The unit will tell you if you have to push the shock button or if it will automatically deliver a shock. If shock is advised, tell all to stand clear.

AED: Everyone clear.

Victoria Vetter, MD, FAAP, FACC: Continue CPR. After shock is delivered, resume CPR until the unit analyzes again.

If a shock is not advised, resume compressions. Continue this cycle until the victim is responsive or until EMS arrives. If the victim wakes up, do not remove the pads from their chest. It is not uncommon for them to experience another arrest and need another shot.

Let's review the steps of using an AED again. First, assess the victim and get an AED. Next, follow the AED prompts.

AED: Tear open package, and remove pads.

Victoria Vetter, MD, FAAP, FACC: Place the electrode pads on the upper right chest and on the lower left chest. Allow the AED to analyze the rhythm and advise shock delivery or not.

If shock is advised, tell all to stand clear. Continue CPR whether shock is delivered or not.

Let's review the steps of using an AED on a child or infant again. Assess a victim and get an AED. Next, follow the AED prompts, then place the electrode pads on the anterior chest over the breast bone and on the center of the infant or child's back. Allow the AED to analyze the rhythm and advise shock delivery or not.

If shock advised, tell all to stand clear. Continue CPR with rescue breaths, whether shock is delivered or not.

First Aid for Choking Victims of All Ages

Victoria Vetter, MD, FAAP, FACC: Hello, my name is Dr. Victoria Vetter and I'm a pediatric cardiologist and the Director of Youth Heart Watch at the Children's Hospital of Philadelphia. This video will demonstrate what to do if choking occurs in an adult, child or infant. Choking is caused when something blocks a person's airway and they are unable to breathe.

If someone is choking, they will not be able to talk and might give you the universal sign for choking with their hands around their neck. If you think someone is choking, ask them.

Man: Dave, are you okay? Are you choking? Can you breathe?

Victoria Vetter, MD, FAAP, FACC: If they are unable to respond or cough, they need your help immediately. Position yourself behind the victim and wrap your arms around them.

Make a fist with one hand and place it just above the belly button. Place your other hand over the top of your fist. Then move your hands in a forceful motion, pushing in and up towards the chest in an attempt to force the item out of the airway. Continue these abdominal thrusts until the item is removed or dislodged, the victim can breathe,

Man: Can you breathe now? Are you okay?

Victoria Vetter, MD, FAAP, FACC: Or they become unconscious. If the victim is large or pregnant, and you cannot wrap your arms around their waist, wrap your arms around their chest to perform five chest thrusts. For a child, you may need to kneel behind them to be at the correct height to fit your arms around their chest.

If the victim loses consciousness, move them to the floor and begin CPR.

The steps for helping a choking infant are different. A choking infant cannot cry or cough and their face may turn blue quickly. You will need to act immediately, by kneeling or sitting down in a chair, and placing the baby face down on your forearm, supporting their head and neck with your hand. Rest your arm holding the baby on your thigh for support.

Use the heel of your hand to deliver five strong blows to the center of the baby's back between the shoulder blades. If the object does not dislodge after five blows, you will need to turn the baby over to perform chest compressions. Place a baby face up on your free forearm, supporting their neck with your hand.

Keeping the baby's head lower than their body, take your free index and middle fingers to perform five compressions in the center of the chest just below the nipple line to dislodge the object that is obstructing the airway. Continue a cycle of five back blows and five chest compressions until the object comes out and the baby can breathe or until they lose consciousness and you need to start CPR.

If the baby loses consciousness, move them to the floor, call 911 and begin CPR. Give 30 chest compressions and then check the airway for the object. If you can see the object and are able to remove it, do so. If you do not see the object, or if it's not easily able to be removed, do not attempt to remove it as you can push the object further into the airway. Instead, give two breaths and then start chest compressions again.

Continue the cycle of chest compressions, checking the airway and breaths until the object is removed, the baby is responsive and crying, or EMS arrives.

Let's review the steps for choking again, for adult or child. Stand behind the victim. Make a fist with one hand, and place it just above the belly button. Then cover the fist with your other hand. Move your hands in and upward, forcefully, until the object is dislodged.

If the victim becomes unconscious, move them to the floor and begin CPR. For a child, you may need to kneel behind them to be at the correct height to fit your arms around their chest.

For an infant. Recognize that a choking infant will turn blue and not be able to cough or breathe effectively. Start back blows for the infant and follow with chest thrust if needed. Use back blows or abdominal thrust -- Heimlich maneuver -- for a child or adult.

Perform CPR if consciousness is lost and a sudden cardiac arrest is occurring.