Professional CPR - Adult, Child, & Infant

CPR is CPR. Whether "Professional" or "Civilian," the patient's heart is still beating in the same place, and breathing is still a process of "sucking" air into the lungs. If your patient has lost one or both of those abilities, you need to replace the missing function(s.)

As a "professional" provider you are expected to be able to:

Locate and palpate pulses (to affirm the absence or presence of "signs of circulation.")

Locate the proper compression site by following the inferior border of the rib cage, from its closest lateral (ipsilateral) aspect, medially, to the intersection of the contralateral border (a point directly above the xiphoid process and on the patient's center line,) and selecting a compression site approximately "two-fingers width" superior to that point.

Properly evaluate the head position (hyperextension or, in the case of the baby, neutral) by visualizing an imaginary line perpendicular to the patient's spine drawn through the patient's earlobe and intersecting either the patient's chin (hyperextension) or the patient's nose (neutral.)

Be able to more closely approximate the proper depth of compression, rate of compression and ventilation

Be able to perform two rescuer CPR.

Be able to use a barrier device, or Bag-Valve-Mask (BVM) for ventilating this patient.

And, you are expected to do so, without any extraordinary show of emotion or confusion, while exercising professionalism and courtesy, in an environment that is very likely to be highly "charged," and possibly "volatile."

Professional CPR

And so, all of the forgoing procedure, regarding each of the three classes of patients, is appropriate for you the "Professional" . In order to achieve the necessary standards of professionalism and perform the procedures within acceptable limits, it is imperative that you practice regularly with manikins, guided by instructors. All of the concepts of CPR apply to two rescuer CPR, regarding when to ventilate or compress, and where to ventilate or compress. However the compression to ventilation ration for two rescuer CPR for a 'child,' is modified to 15:2 (the 'adult' patient remains at 30:2 for two-rescuer CPR.) Rescuers will tire quickly when giving chest compressions, therefore it is suggested that rescuers switch roles every five (5) cycles or about every 2 minutes. Professional rescuers are expected to switch roles in less than five (5) seconds. The skill required to manipulate a bag-valve-mask is one that can only be taught by "hands-on" methods. The confidence to perform under pressure, and under close scrutiny, can only be achieved by repetitive sessions, continued until the skills become second nature. And, the ability to locate pulses and compression sites is one that requires demonstration and repetition. I would not insult your intelligence here by trying to "teach" the skills that you can more than adequately learn from your training officers and fellow rescuers.

Just a final note. When performing CPR in colder environments, it is imperative that all bulky/heavy clothing be removed in order to properly visualize/palpate the proper compression site. Not only will this "padding" hamper your efforts to locate the proper site, it will also act as cushioning between your hands and the patient's sternum, rendering the compressions less effective. In some circumstances, it may be necessary to remove all clothing to accurately locate the proper compression site (use your discretion to protect the patient's right to modesty, but remember that this person is DEAD, and 'protected modesty' will not bring them back.) Removing all clothing would certainly be appropriate (in all cases) if the application of an AED were being considered. That being said, please do not forget (if your patient is female) that this IS someone's sister, daughter, and/or mother. Take ALL possible precautions to prevent this event from becoming a 'side-show.'