CPR consists of chest compressions together with rescue breathing. There is a risk of causing injuries (rib fracture; puncture of the lungs, stomach, or spleen) with CPR, but it is a vital, life-saving technique. CPR is best administered by those trained in the procedure. Everyone should take CPR training.

The ABC's of Emergency Care

A = Airway Airway must be clear and open in order to restore breathing.
B = Breathing Breathing is optimally restored by rescue breathing.
C = Circulation Circulation is optimally restored by cardiopulmonary resuscitation (CPR).

GENERAL GUIDELINES

• Check ABCs (Airway, Breathing, Circulation)
• Call for medical help immediately.
• If child is unconscious or neck injuries are suspected, do not bend or turn child's neck while performing CPR.
• Do not give rescue breathing to any child who is breathing on his/her own.
• Continue CPR do not stop until pulse and breathing begin, a medical professional takes your place, or exhaustion prevents further effort.

These tips have been carefully written to provide parents and other caregivers guidelines for treating children in an emergency. However, it is not intended to take the place of qualified medical care. REMEMBER: when in doubt, do not hesitate to call for emergency medical service! This telephone number is 911.

SYMPTOMS
Breathing Failure - One or more of the following symptoms may be present:

• unconsciousness
• no audible or visible signs of breathing
• noisy breathing, gurgling, wheezing
• blue lips, tongue, and/or nail beds
• dilated pupils

IMMEDIATE TREATMENT

1. Lay child face up on flat surface.
2. Check ABCs
3. Place one hand on childÍs forehead and tilt head back, slightly extending the neck. The other hand should lift chin outward. Do not use head-tilt/chin-lift maneuver if neck injury is suspected.
4. Check for breathing these three ways:
5. Look for the rise and fall of child's chest.
6. Listen for air being exhaled by placing your ear near the child's mouth or nose.
7. Feel for exhaled air at the mouth or nose.

TO RESTORE BREATHING WITH RESCUE BREATHING

1. Keep child's head tilted backward and upward, with one hand on the forehead and the other holding the chin.
2. Pinch child's nostrils closed with your other thumb and index finger.
3. Take a deep breath and place your open mouth over the child's mouth, forming a tight seal. Give two slow breaths, inflating child's lungs enough to make the chest rise. (Take a deep breath through your nose between each blow.) If air goes in and chest rises, check child's pulse.
4. If child is not breathing but has a pulse: Continue blowing into child's mouth at the rate of one breath every 4 seconds (about 15 breaths/minute). Between breaths, remove your mouth from the child's so he/she can exhale your air. Watch child's chest fall. Look, listen and feel for child to begin breathing.
5. Continue rescue breathing until child begins to breath regularly or until medical help arrives.

RESCUE BREATHING FOR INFANTS UP TO 1 YEAR OF AGE:

1. Tilt baby's head back slightly, using head-tilt/chin-lift maneuver.
2. Cover baby's mouth and nose with your mouth. Blow gently with small puffs of air to inflate the lungs enough to make baby's chest rise. Keep one hand on baby's forehead and the other holding chin upward.
3. Repeat breath once very 3 seconds (20 breaths/minute). Remove your mouth from baby's face between breaths to allow baby to exhale.

SYMPTOMS
Circulation/Cardiac Failure - One or all of the following symptoms may be present:

• unconsciousness
• no pulse
• no visible or audible signs of breathing
• blue lips, tongue, and/or nail beds
• cold, grayish-colored skin
• dilated pupils

IMMEDIATE TREATMENT
Call for medical help immediately.
Begin procedures to open airway and restore breathing:

1. Lay child face up on flat surface.
2. Check ABCs
3. Give two rescue breaths. Check for pulse, which should be taken on side closer to rescuer. The carotid artery is located in the neck, between windpipe and angle of the jaw (to the side and above the Adam's apple). Place two fingers lightly on the artery and feel for pulse for 5-10 seconds. For infants, feel for pulse inside the upper arm at the midpoint. Rescuer's hand should remain on child's forehead to maintain an open airway during procedure.
4. If no pulse is felt, the heart has stopped. Begin chest compressions immediately.
5. Give two slow lung inflations.
6. Find the lower tip of the child's breastbone. Then measure upward about two finger widths, and place heel of your hand there. For infants, use two fingers placed midline, slightly below nipples.
7. Depress chest 1-1 1/2 inches, applying steady, smooth pressure. For infants, depress breastbone 1/2-1 inch, using two fingers.
8. Give five compressions, then one slow breath.
9. Repeat cycle approximately 10-12 times each minute. For infants, repeat cycle approximately 15 times each minute.
10. Relax pressure on the chest between each compression to allow child's heart to fill with blood. Compressions are performed at a rate of 80-100/minute. For infants, compressions are performed at a rate of at least 100/minute.
11. Continue to alternate compressions and breaths. Recheck for pulse and normal breathing. Discontinue compressions when pulse is restored; continue rescue breathing until child breathes normally or medical help arrives.