• Failure to breathe, cyanosis
• Inability to move air into lungs with rescue breaths
1. Ensure that the scene is safe. Check for unresponsiveness. Gently tap the person’s shoulder. Ask, “Are you OK?”
2. Simultaneously assess the person's breathing and pulse.
   • Check for breathing. Is the breathing normal, no breathing, or abnormal (only agonal gasps)?
   • Assess the carotid pulse and look for other signs of circulation (no more than 10 sec). If signs of circulation are present but the person is still not breathing, give rescue breaths at the rate of 10 breaths/min (1 breath every 6 seconds).
3. In a sudden collapse, if there is no response with no breathing or abnormal breathing (only agonal gasps) and you are alone, summon help, call a code, activate EMS response via mobile device (if appropriate), phone 911, and get an automated external defibrillator (AED), if available. Send a second rescuer, if available, for help.
4. Position the person supine on a hard, flat surface.
5. If a pulse and signs of circulation are not present, begin chest compressions.
   • Place the heel of one hand on the center of the chest over the lower half of the sternum; place the heel of your other hand over the first.
   Firmly compress the chest at least 2.0 in (5 cm). Push hard and fast. Give 30 compressions. Compress at a rate of at least 100–120/min. Ensure complete chest recoil after each compression. Avoid leaning on the chest between compressions.
6. If the person is not breathing, begin rescue breaths. Open the airway by the head tilt–chin lift method or, if spinal injury is suspected, use the jaw thrust method, if possible.
7. Using a face mask or barrier device, give 2 breaths (1 sec each) with sufficient volume to cause the chest to rise. Do not overventilate. If the chest does not rise, reposition the head, chin, and jaw, and give 2 more breaths. If the chest still does not rise, each time the airway is opened, look for an object in the person’s mouth. Only use a finger sweep to remove material you see obstructing the airway. Never perform a finger sweep if you do not see a foreign body in the airway.
8. Continue to give 30 compressions followed by opening the airway, looking for an object, and performing a finger sweep if object is visible, and then attempt to give 2 breaths.
9. Continue these cycles until an AED arrives. If an AED is unavailable, continue to give 30 compressions followed by 2 breaths.
10. Once AED arrives check for shockable rhythm.
    • Shockable: Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by AED to allow rhythm check).
    • Continue until advanced life support (ALS) providers take over or person begins to move.
11. If circulation resumes but breathing does not resume or is inadequate, continue rescue breathing at 10–12 breaths/min (1 breath every 5–6 sec).
12. If adequate breathing and circulation resume, place the person in the recovery position and monitor until help arrives.

Clinical Tip: An airway obstruction is successfully removed if you see and remove the object or feel air movement and see the chest rise when you give breaths.