For adults:

• Recognize the symptoms

  • Is this person choking (Heimlich maneuver) or having a heart attack?

  • If this person is unconscious, begin CPR by shaking him or her and shouting, "Are you OK?"

• No response

  • Immediately shout, "Help, I need help here!"

  • Tell someone to call 911 immediately.

• Start CPR by remembering A B C: Airway, Breathing and Circulation

• Airway

  • Turn the victim on his or her back, supporting the neck while you turn them over.

  • Tilt the head backward from underneath the chin (Head tilt-Chin lift) to make sure the tongue is not blocking the airway.

  • Open the mouth and remove any vomit, loose dentures or foreign material. If there is still a blockage, perform the modified Heimlich maneuver for unconscious patients.

• Breathing

  • Take five to 10 seconds to check for normal breathing. If not present, pinch the person's nostrils closed so that air cannot escape from the nose when you breathe into the patient's mouth.

  • Take a normal breath and cover the victim's mouth with your own mouth to form a tight seal.

  • Give two rescue breaths to the victim, each over one second. Each breath should make the victim's chest rise. If it doesn't, make sure the head is tilted backward and check for and remove any blockage.

• Circulation

  • Immediately start chest compressions after giving 2 rescue breaths. (Do not check if there is a pulse.)

  • Landmark and hand placement:

    • Find the "V" notch at the bottom of the ribcage, where the two halves of the rib cage join together.

    • Place the heel of one hand on the breastbone, three fingers above the notch.

    • Place the other hand on top and interlock the fingers, making sure to use only the palms. Do not allow the fingers to press into the ribcage.

  • Begin compressions.

    • Press the breastbone until it sinks from 1.5 to 2 inches.

    • Push hard and fast at a rate of about 100 compressions per minute.

    • Allow chest to return to normal position after each compression.

    • Alternate 30 compressions with two breaths (30:2 ratio). Switch positions to fight fatigue without interrupting the rhythm.

For a child (ages 1 through 8):
Do chest compressions with 1 or 2 hands, as needed, to compress the chest 1/3 to 1/2 its depth. If one hand is used, compress the breast bone at about the nipple line, lower half of the sternum. If two hands are used, do compressions using the adult method.

• Perform 5 cycles of CPR (at a ratio of 30 compressions to 2 breaths) for about 2 minutes before calling 911.

• Press the breastbone down about 1/3 to 1/2 the depth of the chest.

For infants:

• Check for consciousness

  • Tickle the infant's feet or pinching the skin.

  • Gently place the infant on its back on a hard, flat surface.

  • Keep the back straight and support the head and neck.

  • Lift the chin and tilt the head back slightly to move the tongue away from the windpipe.

  Watch for breathing for about five seconds.

• If the baby is not breathing, it is vital to get air into the infant before dialing 911

  • Cover the nose completely and gently exhale into the mouth twice, each lasting one second with a pause in between.

  • If the chest does not inflate, reposition the head and try again.

• If the child is choking, begin back blows

  • Lay the infant chest-down along your forearm with the chest in your hand and the jaw between the thumb and index finger.

  • Use your thigh or lap for support.

  • Keep the baby's head below the level of its body.

  • Deliver five forceful thrusts between the shoulder blades with the heel of your hand.

  • Immediately turn the baby over and perform a modified Heimlich maneuver. Place two fingers on the middle of the breastbone, just below the nipples, and give five thrusts down, compressing the breast no more than 1 inch each time. Open the mouth, place a thumb over the tongue and remove any visible and loose objects.

• If the baby has signs of circulation (coughing or movement in response to rescue breaths)

Give one breath every 2 seconds.

• Check the signs of circulation after 30 breaths.

• If no signs of circulation

  • Use one index finger to draw a line between the infant's nipples, stopping in the middle.

  • The tips of the middle and ring fingers will automatically be in the correct position BELOW THE INDEX FINGER on the breastbone for CPR.

  • Lift the index finger, leaving the other fingers in position, and press down 1/3 to 1/2 chest depth 30 times.

Then give another 2 breaths to the infant (30:2 ratio). Call 911 ONLY after 5 cycles of CPR (about two minutes).

External Sources University of Washington School of Medicine American Heart Association

This article was reviewed and updated June 2007.