CPR and first aid, sorted by what kills first

Every emergency starts with two questions, answered while you walk up. Is anything here about to hurt me? Is this person awake and breathing normally? Glance for traffic, smoke, downed wires, deep water or a violent person. Then tap hard, shout, and watch the chest and face. If there is no response and the breathing is absent or just gasps, your check is finished and CPR is next.

Call as early as you can, because the dispatcher is help in its own right. Give your location first, so a crew can still find you if the line drops. Then set the phone on speaker by the person's head. A dispatcher can tell you where your hands go and count with you, and you need no certificate to follow along. In a group, pick one person for one job. "Green coat, call 911" works, while a shout to everybody tends to reach nobody. Send someone else for the AED. With no phone and nobody to send, an adult who collapsed means you go and call, then come straight back to start.

The trap is turning any of this into a reason to wait. People freeze over whether they may touch a stranger or could be sued. Someone who cannot respond is presumed to want help, so go ahead. Good Samaritan laws differ by state, but they broadly protect volunteers acting honestly. An awake adult who can decide gets asked first; if they say no, respect it, call anyway and stay close.

After the call, your job becomes watching. A person who is unresponsive but breathing normally goes on their side so the airway can drain, and you keep rechecking. If breathing stops, roll them onto their back and start CPR. When the crew arrives, tell them what you saw, when it began and what you did.

Picture a man slumped at a bus stop. You check the road, tap and shout, and get one snoring gasp and no answer. You point at the nearest person for 911 and another for the AED, and you are on his chest within seconds.

Rule: look, tap, shout, then give named people named jobs; if the person is not responding and not breathing normally, get to the chest.

When the heart stops, blood stops reaching the brain and damage starts quickly. Your hands take over the pumping. Everything taught about CPR follows from that picture: the push squeezes blood out and the release lets the heart refill, so both halves are doing work.

This keeps the decision short. Not responding plus not breathing normally means start. You do not hunt for a pulse, and a gasp or gurgle is not breathing, however reassuring it looks. Pushing on someone who turns out not to need it rarely does serious harm, while not pushing on someone who does is usually fatal. Do not confuse this with a heart attack, where a blocked artery starves heart muscle and the person is usually awake. In sudden cardiac arrest the heart has stopped pumping and the person goes down. A heart attack can trigger an arrest, and both need 911.

The numbers are few. On a teen or adult, the heel of one hand goes on the center of the chest with the other on top, shoulders over hands, elbows locked. Push about 2 inches deep at about 100 to 120 pushes a minute, with a full rise after each. If you are trained, pause after every 30 compressions for 2 breaths: tilt the head, lift the chin, pinch the nose, and blow for about 1 second each, just enough to lift the chest. If you are untrained, or breaths are not going to happen, push without stopping. For a teen or adult, hands-only CPR is a real option and not a failure.

The trap is gentleness. Pushing this hard feels wrong, so beginners go shallow, rest their weight on the chest, or stop to see whether it worked. Ribs may crack. Ribs heal, while a stopped pump moves no blood, so check your hand position and carry on. Do not spend time looking for a better surface. Roll the person onto their back if needed and start where they lie. Pregnancy is no reason to hold back. With a second rescuer, trade places before you feel spent, since depth fades first.

Your father drops on the kitchen floor, gray and gasping. You call on speaker, kneel and push. Something cracks under your hands early on. You recenter and keep the pace while the dispatcher counts with you.

You stop when the person starts breathing normally or clearly wakes, a trained responder takes over, the scene turns unsafe, or you physically cannot continue. A gasp or a twitch is not a reason to stop.

Rule: hard, fast, full release, few pauses; when you are unsure, push.

Most sudden cardiac arrests come from the lower heart chambers quivering fast and irregularly instead of pumping, a rhythm called ventricular fibrillation. Compressions keep some blood moving, but a shock is what can reset that rhythm, and it works best within minutes. So think of them as partners: CPR buys the time, and the shock treats the cause. Neither should wait for the other.

An AED is built for people with no medical background. It talks you through each step, and it is programmed to shock only when it detects a dangerous rhythm, so a person who has merely fainted does not get one. You cannot make that call wrongly, because it is not your call.

The sequence is short. Turn it on first, then follow the voice. Bare the chest, cutting clothing or moving a bra aside if it blocks a pad, and place the pads as the pictures show, one high on the right chest and one on the left side below the armpit, so the heart sits between them. Nobody touches the person during analysis or the shock, so look down the whole body and say "clear" out loud. If it tells you to press the shock button, press it; some units shock on their own after a warning. Then push again at once, whether it shocked or not. A no-shock message means only that a shock cannot help this rhythm. It does not mean the person is fine.

The trap is treating small obstacles as reasons to delay. A wet chest gets wiped. A person lying in standing water gets moved, but rain or a damp floor is no reason to hold back. On thick hair, press the pads down hard; if the machine complains, pull them off and use a spare set or the kit's razor. A medication patch in a pad's spot comes off, using gloves or a cloth if handy. A bump under the collarbone may be an implanted device, so set the pad beside it. On a child, use child pads if you have them and adult pads if you do not, keeping them from touching, one on the front and one on the back if needed. An adult gets adult pads, since child pads may deliver too little.

Getting the device should not stop the pump. Send a helper for it if you can. Alone, grab one that is within easy reach; otherwise stay and push.

At the gym, a coworker runs up with the wall unit while you are compressing. You keep pushing as she powers it on and places the pads, and you lift your hands only when the voice says to. It says no shock is advised, and your hands go straight back.

Rule: power first, pads next, hands off only when told, and back on the chest the moment it finishes.

One difference explains nearly everything that changes with age. An adult who drops suddenly usually has an electrical problem in the heart, and the blood still holds oxygen. A child's heart is usually healthy, and it stops because choking, drowning or a severe breathing illness has already used that oxygen up. So a child needs both compressions and breaths. That is the reason, and it is easier to keep than a list of exceptions.

The rest scales to the body. Keep the same pace of about 100 to 120 pushes a minute, but push about one third of the depth of the child's chest. One hand may reach that on a small child, and two hands are fine on a larger one. An infant, meaning under one year, gets the same one-third depth from a much smaller area, on the breastbone just under the line between the nipples, a head kept close to level rather than tilted far back, and small puffs of air. Your course will show the finger or hand method it currently teaches, and a dispatcher can talk you through it. You do not need an exact age. Judge by size, and use adult technique once puberty has begun.

The trap is fear. Rescuers push too shallowly on a small body, or stall while trying to recall the right age band. Rough technique on the wrong band still moves blood, and waiting moves none. A close second is holding back because you cannot give breaths. Breaths matter most here, yet pushing alone is still far better than doing nothing.

Calling changes too, if you have no phone and nobody to send. A brief period of CPR comes before you leave a child to get help, since oxygen is the urgent problem; a phone on speaker removes the choice. A sudden collapse in a child, with no breathing illness before it, points to the heart, so get the AED quickly.

You can often act before any of this. Hard work to breathe, skin pulling in between the ribs, flaring nostrils, grunting or bluish lips all mean oxygen is running short, so call 911 now. A child who turns quiet and drowsy is not getting better.

A babysitter lifts a toddler from a wading pool, limp and not breathing. She calls on speaker, gives breaths, and pushes a third of the way into the small chest while the dispatcher coaches her.

Rule: in a child, think oxygen first, and scale your force to the body while keeping the urgency the same.

Choking comes in two forms, and the correct response to one is wrong for the other. In a partial blockage, air still moves, the person can cough hard and may speak, and that cough is a better tool than anything you can do. Stay with them and watch. In a severe blockage, the cough goes weak or silent, they cannot answer, and they may clutch their throat. After more than four minutes without oxygen, the brain can be damaged or the person can die, so now you act.

Ask, "Are you choking?" An answer means air is moving. A frantic nod with no voice means it is not.

The response is a pair of techniques, with someone calling 911 as you start. Alone, act first and call when you can. Lean the person forward and strike firmly on the upper back, between the shoulder blades, using the heel of a hand. Then stand behind them, set a fist just above the navel, grab it with your other hand, and pull sharply in and up, which forces air out of the lungs like a cough. Keep alternating until the object comes out, they can breathe, or they collapse. Courses differ on the order and on how many of each, so do not pause to remember the count. If you cannot reach around the waist, or the person is late in pregnancy, thrust on the center of the breastbone instead.

Two traps sit on either side. Hitting someone who is coughing well can shift the object and close what was open. Waiting on someone who has gone silent loses the minutes that matter. And a baby needs a separate method, because thrusts on the belly can injure organs in a body that small. Under one year, lay the infant face down along your forearm, jaw supported and head low, give back slaps, turn the infant over and give chest thrusts on the breastbone, and keep alternating.

If anyone goes unresponsive, lower them to the floor, get 911 on the way and begin CPR, because compressions can move the object too. Look in the mouth before giving breaths and remove only what you can see, since a blind sweep can push it deeper. Anyone who needed thrusts should be checked afterward, even if they feel fine.

At a restaurant, a man stands up with both hands at his throat and no sound. He nods when you ask. You lean him forward and strike, then thrust. He sags against you, so you ease him down, a server calls, and you start compressions.

Rule: if they can cough hard, coach; if they cannot, clear; if they collapse, compress.

Think of a clot as a seal that needs time and stillness to form. Judge a wound by how much blood is leaving, not how the wound looks: spurting, pooling on the ground or clothes that keep soaking all count, and 911 starts now.

Press directly where the blood is coming from, using gauze, the cleanest cloth in reach, or your hand if nothing else is there. Gloves help, but never wait for them. Put your body weight behind straight arms. If blood comes through, add more on top and press harder. Peeling off the first layer to look is the classic mistake, because it pulls the forming clot away with it.

On an arm or leg, when pressure is not holding a life-threatening bleed, or plainly cannot, as with a limb torn away, a tourniquet goes on. It sits a little above the wound, on the trunk side, never over a joint, and it tightens until the bleeding stops. That will hurt badly, and easing off because someone asks makes it worse, since a loose band traps blood in the limb and bleeding increases. Note the time and leave it on; only the medical team takes it off. A thin cord fails, so an improvised one needs wide cloth and a twisting rod; with neither, keep pressing. The groin, armpit and base of the neck cannot take a tourniquet, so gauze or cloth gets fed deep into the wound, onto the source, and held under hard pressure. Never pack the chest or abdomen; cover those wounds. Leave an impaled object in place and press around it.

Heavy loss leads to shock, in which blood and oxygen stop reaching the organs. Watch for pale, sweaty skin, cool hands, a fast weak pulse, rapid breathing and confusion. After a crash, those signs with little visible blood may mean internal bleeding, which only a hospital can stop, so call. Lay the person flat, keep them warm and give nothing by mouth.

For a small cut, rinse with clean water and press with gauze. If it still bleeds after 10 minutes of firm pressure it needs medical care, as does a deep, gaping, dirty or rusty one. Heavy bleeding never waits for that clock. For a nosebleed, lean forward and pinch the soft part of the nose without stopping to check.

A saw opens a coworker's forearm and blood runs through the towel. You stack a second towel and lean in while someone calls. It keeps coming, so you put the kit's tourniquet above the elbow and twist until the flow stops. He shouts. You keep it tight and write down the time.

Rule: press first, add rather than peel, and once a tourniquet is on, leave it on.

You cannot diagnose on a sidewalk, and you do not have to.

For heart attack and stroke, treatment lives in the hospital, so call 911 fast. A heart attack can feel like pressure or fullness in the chest, discomfort in an arm, back or jaw, or only breathlessness, and people often take it for indigestion. For stroke, check for a drooping face, a drifting arm and strange speech. One finding is enough, even if it fades, and note when it began. A dispatcher may suggest aspirin for a suspected heart attack, but stroke gets nothing by mouth, aspirin included, since it may be a bleed. If you cannot tell chest pain from panic, treat it as the heart.

Opioid overdose shows as slow or stopped breathing, tiny pupils and gurgling: call 911 and give naloxone if you have it, and more if the first does nothing. It does no harm if opioids turn out not to be involved, so suspicion is enough. Anaphylaxis, a severe allergic reaction, can bring hives, a swelling throat, wheezing or fainting, and a rash need not appear: use the epinephrine auto-injector right away and call. In an asthma attack, sit the person up and help with their quick-relief inhaler, and call 911 if it fails. Low blood sugar brings shaking, sweating and confusion that can pass for drunkenness: someone awake who can swallow gets juice or glucose tablets and a recheck after about 15 minutes, and someone who cannot gets nothing by mouth, glucagon if it is at hand, a position on their side, and 911.

A seizure needs protection, not force. Move hard objects away, cushion the head, do not hold the person down, put nothing in the mouth, and time it. Most last 30 seconds to 2 minutes. Call 911 past 5 minutes, for one after another without waking, or for a first seizure or one in water. Roll the person on their side afterward. If someone faints, lay them flat and check breathing. A faint with chest pain or during exercise needs immediate care. Anyone who stops responding and is not breathing normally gets CPR at once, ahead of any medicine.

If someone may be thinking of suicide, stay with them and call or text 988; if life is at risk, call 911.

The trap is improvement. Naloxone lasts only 30 to 90 minutes and many opioids outlast it, and epinephrine fades too, so a person who wakes up can slide back. A friend revives after naloxone, says he is fine and heads for the door. You talk him into staying until the crew arrives.

Rule: when you suspect it, act and call; feeling better is not a reason to cancel.

The model: remove the cause, then support the person.

Water comes first. Drowning is often quick and silent, so check on a swimmer gone quiet and upright. Reach or throw from a secure spot, since going in can make two victims. Anyone pulled out not responding and not breathing normally needs CPR, with breaths if you can give them; never try to drain water first. Carbon monoxide has no smell: get everyone out and call from outside. For a swallowed poison, call Poison Control at 1-800-222-1222, but call 911 if the person has collapsed or cannot breathe, and do not make them vomit.

Heavy sweating, a fast weak pulse and clear thinking suggest heat exhaustion, so cool them down and offer sips if they are alert. Treat confusion or collapse as heat stroke: call 911 and cool them at once, in a tub of cold water with the head held clear if you can, otherwise with soaked towels and ice. Dry skin is the textbook sign, but hard exercise can leave someone sweating, so thinking is the test.

Sleepiness, clumsiness and confusion suggest hypothermia, and a body temperature below 95 degrees F is an emergency, so call 911. Shivering that stops is a bad sign. Move the person gently, warm the trunk, give no alcohol, and do not give up on CPR. Frostbite looks white or waxy and feels numb: use warm, not hot, water, unless it may refreeze, and never rub it or use dry heat.

For burns, run cool water right away, take off rings, and cover loosely. Call 911 for burns that are large or deep, or that involve the face or hands. Brush off a dry chemical before flushing, and cut the power before touching someone who was shocked.

Injuries wait their turn unless they affect breathing or bleeding. Splint a suspected break as you found it. After a fall or crash, keep the head and neck still unless danger, vomiting or CPR forces a move. A headache that worsens, repeated vomiting, trouble waking or growing confusion after a head injury needs help now. Wash an animal bite with soap and water and get a deep one checked. For a snakebite, call 911, take off rings and keep the person as still as you can.

The trap is folk remedies: butter or ice on burns, rubbing frostbite with snow, cutting, sucking or tying off a snakebite. They cost time or tissue.

A runner at a summer race is soaked in sweat and talking nonsense. The sweat misleads; the nonsense decides. You call 911 and pour on cold water.

Rule: remove the cause, skip the folk remedy, and treat any change in thinking as the alarm.