When do you start CPR?

When to Start CPR: Critical Assessment Steps

You should start CPR immediately when a person is unresponsive and not breathing normally or only gasping, with no pulse felt within 10 seconds. 1

Step-by-Step Algorithm for Determining Need for CPR

1. Assess Scene Safety

• Ensure the environment is safe for you to approach the person
• Remove any potential hazards before proceeding

2. Check Responsiveness

• Tap the person's shoulders firmly
• Shout loudly to see if they respond
• If no response, proceed to next step

3. Call for Help

• Shout for nearby help
• If alone, activate emergency response system (call emergency services)
• If possible, send someone to get an AED

4. Check Breathing and Pulse Simultaneously (Critical Decision Point)

• Look for normal breathing (not just gasping)
• Check pulse (carotid for adults/children, brachial for infants)
• Important: Spend no more than 10 seconds checking for pulse 1

5. Decision Based on Assessment

• If breathing normally AND pulse present: Monitor until emergency responders arrive
• If not breathing normally BUT pulse present: Provide rescue breathing (1 breath every 6 seconds for adults, 1 breath every 2-3 seconds for children)
• If not breathing normally OR only gasping AND no pulse: Begin CPR immediately

Key Considerations for Accurate Assessment

Recognizing Agonal Breathing

• Agonal breathing (slow, irregular gasping) is present in 40-60% of cardiac arrest victims 2
• This is NOT normal breathing and is often mistaken as a sign of circulation
• If you see agonal breathing (gasping, snoring respirations), treat as cardiac arrest and begin CPR 1

Pulse Check Challenges

• Research shows pulse checks are often inaccurate and time-consuming 3, 4
• Healthcare providers frequently take too long to check for a pulse
• Only 15% of rescuers can accurately determine pulse status within 10 seconds 3
• If uncertain about pulse within 10 seconds, begin CPR

CPR Implementation

• For adults: 30 compressions to 2 breaths
• For children with two rescuers: 15 compressions to 2 breaths
• Push hard (at least 2 inches for adults) and fast (100-120 compressions per minute)
• Allow complete chest recoil between compressions
• Minimize interruptions in chest compressions

Common Pitfalls to Avoid

1. Delaying CPR while checking for pulse too long: If you cannot definitely feel a pulse within 10 seconds, start CPR 1

2. Misinterpreting agonal breathing as normal: Gasping is a sign of cardiac arrest, not adequate breathing 2

3. Fear of causing harm: The risk of harm to a patient who is not in cardiac arrest is low compared to the risk of withholding CPR from someone who needs it 1

4. Waiting for AED before starting compressions: Begin CPR immediately while waiting for the AED to arrive 5

5. Checking pulse immediately after defibrillation: Resume CPR immediately after shock delivery without checking pulse 5

Remember, early recognition and immediate action are crucial for survival. When in doubt, it's better to start CPR than to withhold it from someone who needs it.