In this section, we're going to cover two-responder adult CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.)
The advantage of having a second, fully-trained and experienced rescuer is that the two of you can share in tasks and responsibilities. Rather than one of you having to do it all on your own.
The type of rescue mask you're using doesn't change the two-responder technique when it comes to the sharing of duties; neither does the presence or absence of supplemental oxygen.
Pro Tip #1: The advantage of two -responder CPR is the alleviation of rescuer fatigue. Performing the compressions and rescue breaths yourself will begin to tire you over time and perhaps diminish the quality of CPR being administered.
The assessment phase is similar to one-responder situations, however, while one of you is assessing the scene and patient, the other can get the equipment ready to perform CPR, try to locate an AED if one isn't present, call 911 or a code, etc. Once chest compressions begin, that's when the efforts of each responder will begin to coordinate, including the important switch at the two-minute mark.
Warning: The point of two-responder CPR is to limit fatigue and maintain the delivery of high-quality CPR. So, don't negate this benefit. Be sure to coordinate a switch at the two-minute mark so neither of you are performing chest compressions for longer than two minutes without a rest.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your bag valve mask, or rescue mask with a one-way valve (or bag valve mask when there are two responders), handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR.
Two-Responder CPR Technique for Adults
Responder one:
- Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
- Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them.
Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.
- Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 30 chest compressions.
Pro Tip #2: Counting with the correct cadence and out loud will help you maintain a consistent rhythm. However, when there are two responders, counting out loud is even more important. It allows the other responder to anticipate the delivery of rescue breaths and the all-important switching of duties.
Responder two:
- Grab the rescue mask and seal it over the victim's face and nose.
- Lift the victim's chin and tilt his or her head back slightly. (When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do.)
- Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath.
Responder one:
- Go right back into your 30 chest compressions.
Responder two:
- Go right back to delivering two rescue breaths.
Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties.
Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask.
- Continue to perform 30 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
A Word About Considerations for Older Adults
In older adult patients, a general decrease in pain perception may cause a different reaction to a heart attack. Older adults often suffer what is known as a silent heart attack, meaning there is a lack of common symptoms we most often associate with heart attacks – chest pain or pressure, for instance.
For these older adult patients, the symptoms of a heart attack mostly tend to include general weakness or fatigue, aches or pains in the shoulders, and indigestion and/or abdominal pain.
