slide on cpr

1. Created by :Akangshaw anne paiva

2. INTRODUCTION:-
Sudden death occur when heartbeat &
breathing stop suddenly or unexpectedly.
the major role of CPR is to provide oxygen to
heart ,brain,& the other vital organ until
medical treatment (advance cardiac life
support-ACLS) can restore normal heart
action.

3. DEFINITION:-
Angela Morrow RN
Cardiopulmonary resuscitation (CPR) is a
procedure used when a patient's heart stops beating and
breathing stops. It can involve compressions of the chest or
electrical shocks along with rescue breathing.
Mosby medical dictionary
CPR is a basic emergency procedure for life
support consisting of artificial and manual external cardiac
massage

4. Anatomy and physiology

5. CHAINOFSURVIVAL:-

6. INDICATIONS:-
Cardio vasculardisorders
CAD, congenital heart diseases , coronary
embolism, cardiac rupture &dissection
Pulmonary causes
pulmonary embolism, pulmonary edema, asphyxia
Metabolic causes
hypoglycemia, electrolyte imbalances

7. Fluid imbalance
extensive hemorrhage, hypotension, shock
Neurological causes
brain injuries, massive CVA
Poisons substance and drug overdose
co poisoning, propanolol over dose
Other causes
electrical shock, hypothermia, narcoticoverdose

8. Respiratory Arrest
• This may be result of following:
• Drowning
• Stroke
• Foreign body in throat
• Smoke inhalation
• Drug overdose
• Suffocation
• Accident, injury
• Coma
• Epiglottis paralysis.

9. WARNINGSIGNSOFCARDIO PULMONARYARREST:-
Early signs:
. loss of consciousness &convulsions
Late signs:
. Apnoea
.Dilated pupils
.Absence of heart sounds

10. Other signs
 Changes in respiratoryrate
 Aweak or irregular pulse
 Bradycardia
 Cyanosis
 Hypothermia

11. • To restore effective circulation and ventilation.
• To prevent irreversible cerebral damage due to
anoxia. When the heart fails to maintain the cerebral
circulation for approximately four minutes the brain
may suffer irreversible damage.

12. PHYSIOLOGY OF CPR
• When a person experience cardiac arrest the heart goes from normal beat to an
arrhythmic pattern called ventricular fibrillation, and eventually ceases to beat together
• This prevent oxygen from circulating throughout the body, rapidly killing cells and
tissues.
• Cardiac (heart) pulmonary( lungs) Resuscitation ( revive, revitalize) serve as artificial
heartbeat and respiration if given within 10 minutes ,there is 40% of chance of survival

13. • During CPR blood is circulated foreword by two mechanisms, cardiac pump
mechanisms , and thoracic pump mechanisms
• Cardiac pump mechanism: Direct compression of the heart between the
sternum and the spine forces blood out and chest also become thoracic pump
• Thoracic pump: chest compressions create a positive pressure that forces
blood out ( cardiac output)of the heart and air out of the lungs ( expels air)
and slightly increase intra cranial pressure which reduce cerebral perfusion

14. • Thoracic pump : decompression : chest wall passively recoils putting a slight
negative pressure (vacuum) in intrathoracic pressure this vacuum draws blood
back into the heart, pulls air into the lungs and fills coronary arteries, lowers ICP
• Alternative negative and positive pressure created by chest compression help to
circulate blood
• preload, output

15. EQUIPMENTS
i. Ambubagandmaskswithdifferent size.
ii. Oropharyngealairways.
iii. Endotrachealtubesofappropriate sizes and
stillet.

16. iv. Paediatriclaryngoscope withstraight
(Miller)and curved (McIntosh)
blade – Appropriatesizes.
v. Suction apparatus.
vi. NGtube.

17. i. IVequipments&fluids
ii. Pulse-oxymetry
iii. Oxygensources
iv. Automatedexternal defibrillator
v. Emergencydrugs
vi. Cardiacmonitor

18. Dr“sABC
b

19. STEPSFORCPR:-
Airway:-Maintaining anopen airway.
Breathing:-Providing artificial ventilationby rescue
breathing.
Circulation:-Promoting artificial circulation by
external cardiac compression.
Defibrillation:-Restoring the heartbeat.

20. STEPSFORCPR:-
Circulation:-Promoting artificial circulation by
external cardiac compression.
Airway:-Maintaining anopen airway.
Breathing:-Providing artificial ventilationby rescue
breathing.

21. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

22. APPROACH
SAFELY!
WATCH
OBSERVE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

23. CHECK RESPONSE
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Shake shoulders gently
Ask “Are you all right?”
If he responds
•Leave as you findhim.
•Find out what is wrong.
•Reassess regularly.

24. Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Approach safely
SHOUT FOR HELP

25. OPEN AIRWAY
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
 Head tilt chin lift manoeuvre
 Jaw thrust manoeuvre

26. Head tilt and chinlift
- Prevent tongue obstructing the upper
airway
- While pushing back the on the forehead
use your hand to lift the chin foreword
- Not applicable on patients with cervical
spine injury
No need for finger sweep unless solid
material can be seen in the airway

27.  Jaw thrust maneuver
It is performed by placing the index and middle fingers to
physically Push the posterior aspects of the lower jaw upwards
while thumbs pushdown on the chin to open the mouth. When the
mandible is displaced forward, it pulls the tongue forward and
prevent it from obstructing the entrance to the trachea

28. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths
CHECK
BREATHING
LOOK
LISTEN
FEEL

29. • Occurs shortly after the heart stops
in up to 40% of cardiac arrests
• Described as barely, heavy, noisy or
gasping breathing
• Recognise as a sign of cardiac arrest

30. Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

31. CHEST COMPRESSIONS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 108
30 chest compressions
2 rescue breaths

32. CHEST COMPRESSIONS
•Kneel next to the person.
•Use your fingers to locate the end of the person's breastbone, where
the ribs come together.
•Place two fingers at the tip of the breastbone.
•Place the heel of the other hand right above your fingers (on the side
closest to the person's face).

33. CHEST COMPRESSIONS
•Use both hands to give chest compressions.
Stack your other hand on top of the one that you
just put in position. Lace the fingers of both
hands together, and raise your fingers so they do
not touch the chest.
•The compression rate is at least 100
compressions a minute.
•If you know CPR and are giving rescue breaths,
give 30 compressions to 2 breaths.

34. CHEST COMPRESSIONS

35. IIN CHILD
•Place the heel of one hand on the breastbone -- just
below the nipples. Make sure your heel is not at the
very end of the breastbone.
•Keep your other hand on the child's forehead,
keeping the head tilted back.
•Press down on the child's chest so that it compresses
about 1/3 to 1/2 the depth of the chest.
•Give 30 chest compressions. Each time, let the chest
rise completely.

36. IN INFANT
•Kneel or stand next to the baby after putting him or her on a flat surface.
•Picture a line connecting the nipples, and place two fingers on the baby's
breastbone just below that line.
•Use just your two fingers to press the chest at least one-third of the depth of
the baby's chest [about 4 cm (1.5 in.)].
Rescue breathing is more important to do
for children and babies than adults. Give
30 compressions to 2 breaths.
Do 5 cycles of 30 compressions to 2
breaths before you call 911.

38. RESCUEBREATHS
Approach safely
Check response
Shout for help
Open airway
Check breathing
Call 112
30 chest compressions
2 rescue breaths
Method:
Mouth to mouth ventilation
Mouth to mask ventilation
Bag mask ventilation

39. AirwayManagement
Mouth – to - Mouth Mouth – to - Mask
If you are uncomfortable doingmouth-
to-mouth then skip it and
Justdo Compressions

40. Adults and Older ChildrenMouth-to-Mouth
Do not give breaths too rapidly or too forcefully. Doing this
may cause air to be forced into the stomach, resulting in distention and
less room for lung expansion. It may also cause vomiting.
1.Open the airway using the head-tilt/chin-lift maneuver.
2.Pinch the person’s nose closed with your hand on the person’s head.

41. • Create a seal when using your lips to
surround the person’s mouth.
• Blow into the person’s mouth for one
full second and watch for chest to rise
.Tilt the victim’s head further back if the
chest does not rise.
• Give an additional breath for over one
second.
• If you cannot see the chest rise in two
breaths, continue giving chest
compressions.

42. Infants Mouth-to-Mouth/Nose
When performing rescue breathing on an infant, the rescuer should
cover the infant’s mouth and nose when possible and do the following:
Open the airway using the head-tilt/
chin-lift maneuver. Be sure not to hyper-
extend the neck

43. •Create a seal using your lips to surround the infant’s
nose and mouth
•Gently blow into the infant’s nose and mouth for
one second
• Keep in mind that an infant’s lungs are smaller
than an adult’s and need a smaller volume of air.
Watch for the infant’s chest to rise. If you cannot see
the chest rise, re-adjust the tilt of their head.
•Give an additional breath and watch for the infant’s
chest to rise. If unable to cover both mouth and nose
entirely with your mouth, use the following method
for rescue breathing:
•a. Open the airway using the head-tilt/ chin-lift
maneuver.
•b. Pinch the infant’s nose closed.

44. Age Group How Often
Breaths per
Minute
Duration Evaluation
Adult
every 5 to 6
seconds
10 to 12
breaths per
minute
each breath
should last
one second
check for
chest rise
and
breathing;
check pulse
and begin
CPR if
necessary
Child/Infant
every 3 to 5
seconds
12 to 20
breaths per
minute

45. What to do if the person recovers during
CPR???
• Review the persons condition if signs of life return( coughing ,
movement, normal breathing)
• If the person is breathing on their own, stop CPR and place them
on their side with head tilted back
• Be ready to recommence CPR if the person stops breathing or
become unconscious or unresponsive again.

46. POOR CPR
• Hyperventilation limit preload and increase ICP
• Compressing to slow fails to generate enough pressure within
circulatory system
• Compressing to fast limit preload because heart does not get enough
time to fill with blood
• So if chest wall does not recoil completely

47. QUALITY CPR
• Minimize interuptions
• Provide correct chest compressions
• rate (100-120)/ min)
• Depth ( atleast 2 inch or 50mm)
• complete chest wall recoil
• Provide correct ventilations
• Rate: less than 12 breaths / min
• duration of 1 second

49. (D)DEFIBRILLATION:-
Device that delivers direct electrical current across the myocardium. The aim is
to produce synchronous depolarization of cardiac muscle
STRATEGIES:
Test defibrillate for
 full batterycharge
 switch on power button
 change paddlemode

51. (D)DEFIBRILLATION:-
Paddle site: Rt intraclavicular region
lt loweraxillary region
Paddle size: 8cm-12cm
wave form patterns :
monophasic
biphasic truncated exponential
biphastic rectilinear
Energy level
Pediatric : 2-4 J/kg
Adult : Monophasic=> 360J
Biphasic truncated=> 150-200J
Biphasic rectilinear=> 120J

53. STEPS:-
 switch on
 select paddle mode
 assess rhythm
 press paddles firmly over the chest
 deliver the shock
 resume cpr

54. • Coronary vessel injury
• Diaphragm injury
• Hemopericardium
• Hemothorax
• Interference with ventilation

55. • Liver injury
• Myocardial injury
• Pneumothorax
• Rib fractures
• Spleen injury
• Sternal fracture

56. Adrenaline
• Adrenaline (epinephrine) is the main drug used during
resuscitation from cardiac arrest.
Atropine
• Atropine as a single dose of 3mg is sufficient to block vagal
tone completely and should be used once in cases of asystole.
It is also indicated for symptomatic bradycardia in a dose of
0.5mg - 1mg.
Amiodarone
• It is an antiarrhythmic drug.

57. • Maintains airway patency with use of airway adjuncts as
required (suction, high flow oxygen with O2 or bag valve mask
ventilation).
• Assist with intubation and securing of ETT
• Inserts gastric tube and/or facilitates gastric decompression
post intubation as required.
• Assists with ongoing management of airway patency and
adequate ventilation

58. • Supports less experienced staff by
coaching/guidance e.g. drug preparation
• If a shockable rhythm is present (VF/VT)
ensure manual defibrillator pads are applied
and connected.
• If CPR is in progress, prepare and independently
double check and label 3 doses of adrenaline
• Prepare and administer IV fluids
• Document medications administered
(including time)

59. POSTCARDIACARRESTMANAGEMENT:-
Continued care
 To ensure hemodynamic monitoring
 To minimize the effect of loss of spontaneous
circulation of various organs
 To recognize and treat recurrent cardiac arrests
Objectives:
 Optimize cardio pulmonary function& systemic
perfusion
 Transport victim out of hospital
 Identify and treat thre precipating factor
 Intitute measure to prevent recurrence and improve
neurological function

60. Respiratory system;
• Intubate &mechanically ventilate until they are stable
• Administer supplemental oxygen
• Obtain chest x ray
• Administer drugs
• Avoid hyperventilation
• Obtain expert consultation
• Monitor ecg , x-ray, labanalysis,
• Monitor intra arterial blood pressure
• Administer drugs
Cardio vascularsystem:

61. RECAPITUALIZATION

62. Research studies