Where would a first responder try to find a pulse in a patient who has been knocked unconscious?

American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ed. Dallas, TX: American Red Cross; 2016.

Crocco TJ, Meurer WJ. Stroke. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 91.

De Lorenzo RA. Syncope. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 12.

Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association focused update on adult basic life support and cardiopulmonary resuscitation quality: an update to the American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;137(1):e7-e13. PMID: 29114008 pubmed.ncbi.nlm.nih.gov/29114008/.

Lei C, Smith C. Depressed consciousness and coma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 13.

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Berger JR, Price R. Stupor and coma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 5.

Lei C, Smith C. Depressed consciousness and coma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 13.

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Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84(16):1705-1713. PMID: 25901057 pubmed.ncbi.nlm.nih.gov/25901057/.

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Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Why do I have to tilt their head back to check for breathing?

When someone is unresponsive, their tongue can fall backwards and block their airway. Tilting their head backwards opens the airway by pulling the tongue forward.

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What should I do if I hear noisy or irregular breathing?

Sometimes when a person is unresponsive their breathing may become noisy or irregular, or they may be gasping. This is usually a sign that their heart is not working properly and you should start chest compressions.

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What should I do if I’m on my own when I find someone unresponsive and not breathing?

If you are on your own, call 999 before you start chest compressions.

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What are chest compressions?

Chest compressions are where you place your hands in the centre of the chest and repeatedly press downwards and release at a regular rate to help pump the blood around the body.

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How long should I do chest compressions for?

Keep going until help arrives. If there is someone else who can help, change over every minute or two. Try to keep doing chest compressions with as little interruption as possible when you change over.

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If I press too hard during chest compressions, could I break their ribs?

You might, but try not to worry. Your priority is to keep the blood circulating. A damaged rib will mend, but if you don’t do chest compressions their chances of survival are much lower.

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Should I do chest compressions differently on a child or baby?

Yes, chest compressions should be done slightly differently for children or for babies. For a child over one, use only one hand to do chest compressions. For a baby under a year old, use two fingers to do chest compressions.

Find out:

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What if I make a mistake and do chest compressions but the person is still breathing?

It’s not ideal but don’t worry. There’s no evidence to suggest you will cause any serious damage.

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Am I supposed to give rescue breaths too?

If you feel able to, combine chest compressions with breathing into their mouth or nose.

However, giving chest compressions is the most important thing to do because their blood already has some oxygen in it and the compressions will keep that blood pumping around their body, taking oxygen to their brain.

Breathing into their mouth or nose tops up the oxygen in their lungs. The combination of continuous cycles of 30 chest compressions followed by two breaths is called CPR (cardiopulmonary resuscitation).

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How do I give rescue breaths?

If you feel able to give rescue breaths, you can do so after about 30 pushes on their chest.

To give rescue breaths, tilt their head back and seal your mouth over either their mouth or nose. Blow air into them with two steady breaths. If you are breathing into the mouth, pinch the nose. If you’re breathing into the nose, shut their mouth.

On a baby under a year old, seal your mouth around both their nose and mouth because their faces are small.

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Will I restart the heart if I give chest compressions?

The chance of restarting the heart by chest compressions alone is very small. Usually, a heart needs an electric shock from an automated external defibrillator (AED) to restart.

Chest compressions pump a small amount of blood around the body to keep the organs alive, most importantly the brain.

Don’t give up even if you do not see any change in the person’s condition. Chest compressions significantly increase the chance of the person surviving.

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What is an automated external defibrillator (AED)?

An AED is a machine that can be used to shock the heart back into normal rhythm.

When you open an AED case it will give you full instructions on what you should do.

Find out how to help someone who is unresponsive and not breathing when an AED is available.

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What should I do if someone has been rescued from drowning and is unresponsive and not breathing?

Get the person safely to dry land without putting yourself in danger.

Check to see if they are breathing by tilting their head back and looking and feeling for breaths. If they are unresponsive and not breathing, push firmly downwards in the middle of their chest at a regular rate.

Ideally, you should alternate two rescue breaths with 30 chest compressions for anyone who has been rescued from drowning. This will help build up a supply of oxygen in their blood.

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Email us if you have any other questions about first aid for someone who is unresponsive and not breathing.