Calliper Method

The middle finger of one hand is placed on the `sternal notch', the depression above the sternum below the throat. The middle finger of the other hand is placed at the base of the xiphoid process. Both hands are then moved together so that the thumbs meet in the middle of the sternum. The lower hand is then positioned palm down across the lower part of the sternum, close to the thumb of the upper hand. This approximates the location of the heart.

For adults and older children place one hand in position, the second hand is positioned over the first and the fingers entwined for stability. An alternative is for the second hand to grip the wrist of the first. The chest is then compressed approximately 1/3 the depth of the chest with pressure exerted through the heel of the bottom hand.

Hand position for a young child is on a point centrally located on the lower half of the sternum. Compressions are performed approximately 1/3 the depth of the chest using the heel of one hand only. The pressure is modified so as not to cause damage to the ribcage.

An infant's heart is located by placing two fingers centrally on the sternum, 1 finger breadth below the inter-nipple line. Compressions are then performed by pressing with the fingers approximately 1/3 the depth of the chest. The pressure is modified to reflect the fragility of the child's chest. The pulse is detected by placing two fingers directly over the infant's upper arm just above the elbow. This should indicate the brachial pulse.

CPR can be performed by a single rescuer for all age groups, or by two rescuers for adults and older children. As two-person CPR requires a degree of synchronised technique, it is usually more effective for first aid providers to perform individual CPR, and change operators after five minutes or so.

INDICATIONS FOR CPR:

• unconsciousness
• usually no respirations, although there may be brief irregular, 'gasping' breaths
• no pulse

PROCEDURE FOR ADULT AND OLDER CHILD ONE-PERSON CPR:

• check for DANGER
• check for response, gently shake and shout
• call for help
• roll casualty away from you
• check and clear airway
• look, listen and feel for breathing
• If not breathing place casualty on back on a firm flat surface
• open airway
• give two effective breaths
• assess the rise and fall of the chest
• check for carotid (neck) pulse (5 - 10 seconds)
• kneel beside casualty's chest
• locate correct hand position
• place hands centrally over heart, fingers entwined
• lean over casualty, arms straight, elbows locked
• commence 15 compressions, with even pressure approximately 1/3 the depth of the chest
• compressions - rate of 100 per minute
• give two effective breaths
• relocate correct hand position
• 15 compressions
• continue cycles and recheck pulse around every 1 minute

PROCEDURE FOR YOUNG CHILD AND INFANT CPR:

• begin immediately
• check for DANGER
• check for response, gently squeeze the shoulder and shout
• roll casualty away from you
• check and clear airway
• look, listen and feel for breathing
• If not breathing place casualty on back on a firm flat surface
• open airway
• initial two effective breaths or puffs
• check for carotid pulse (5 - 10 seconds)
• 5 compressions
• 1 breath or puff delivered on completion of the fifth compression
• continue cycles and recheck pulse about every 1 minute 

PROCEDURE FOR TWO-PERSON CPR:

• check for DANGER
• check for response, gently shake and shout
• call for help
• roll casualty away from you
• check and clear airway
• look, listen and feel for breathing
• If not breathing place casualty on back on a firm flat surface
• one rescuer positions close to the casualty's head and delivers breaths
• the other positions on the opposite side of the body beside the chest and performs compressions
• open airway
• initial two effective breaths
• check for carotid pulse (5 - 10 seconds)
• 5 compressions
• 1 breath delivered on completion of the fifth compression

As air is forced under pressure into the casualty, and pressure is exerted by compressions, the risk of causing the casualty to vomit is very real. Rescuers must be alert at all times to avoid the airway becoming soiled by vomitus. Upon detection of vomitus in the casualty's mouth, roll him/her into the stable side position, clear the airway, and when clear, roll casualty back and resume CPR.

CPR is to be continued once begun until either the casualty is revived, the rescuer is relieved by expert medical aid, or until the rescuer is too exhausted to continue. Should the casualty regain his/her pulse and breathing, put him/her into the stable side position and observe closely, as often the casualty lapses back into cardiac arrest. If pulse only returns, continue with EAR.

RESUSCITATION SUMMARY CHART: