If the heart stops beating, blood flow to the brain and other vital organs ceases. With each heartbeat blood surges through the arteries, giving a pulse or throb which can be felt at various points on the body. Normal pulse rate is 60-80 beats per minute in adults; in infants and young children it is faster, in elderly people and very fit people somewhat slower.
Taking the Pulse
You can hear a person's heart by pressing your ear to his or her chest. The strongest pulse is usually just below the angle of the jaw, where the external carotid artery runs up beside the larynx. The radial pulse in the wrist at the base of the thumb is also easy to feel.
Feel for the pulse with the tips of your fingers (not your thumb, as it has a pulse itself). Count the number of beats per minute and note if it is fast or slow, full or weak.
If the heart is not beating, there will be no pulse and no detectable breathing, and the casualty will be unconscious, and either pale or blue, especially round the lips. If you are in any doubt as to whether the casualty is breathing normally, contact emergency services, sending a helper if available and then give CPR (cardio-pulmonary resuscitation). If you are alone with a case of drowning or an unconscious child, carry out CPR for one minute and then get help.
Cardio Pulmonary Resuscitation (CPR)
Put the patient on his or her back and kneel beside their chest. Press the heel of your hand in the centre of their chest, and place the heel of your other hand on your lower hand, keeping pressure in the centre and not on the ribs. Holding your arms straight and leaning over the casualty, press straight down, springing the breastbone down by about 5 cm (2 in) for an adult then allowing it to come back up fully. Do thirty of these chest compressions at a rate of about 100 per minute, then give two rescue breaths:
- Open the patient’s airway by tilting the head back and lifting the chin up to open the throat and mouth.
- Close the patient’s nostrils, using your index finger and thumb. Allow the mouth to open, but maintain chin lift.
- Take a normal breath and place your lips around his mouth, making sure that you have a good seal.
- Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath.
- Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.
- Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions.
- Continue with chest compressions and rescue breaths in a ratio of 30:2. Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.
- If your rescue breaths do not make the chest rise as in normal breathing, then before your next attempt:
- Check the victim's mouth and remove any visible obstruction.
- Recheck that there is adequate head tilt and chin lift.
- Do not attempt more than two breaths each time before returning to chest compressions.
- If there is more than one rescuer present, another should take over CPR about every 2 minutes to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers.
- Continue CPR until the casualty is breathing again un-aided, then put him or her in the recovery position (see Unconsciousness).
If the Casualty is a Child
- Clear the mouth of any obvious obstructions and tilt the head back as above.
- Give five initial rescue breaths then commence the cycle above (30 chest compressions then 2 rescue breaths), compressing the chest by one-third of its depth only.
- If the first breaths aren’t effective in making the chest rise, check the mouth again but make no more than five attempts at rescue breaths each time before commencing chest compressions.
- For chest compressions on small children, use the heel of one hand only and on infants under a year old, use your fingers only.
- If you are not able, or are unwilling, to give rescue breaths, give chest compressions only. If chest compressions only are given, these should be continuous at a rate of 100 a minute.