2. Introduction
1960 CPR program was started by American heart association and in 1966 guidelines
were given by AHA.
Cardiopulmonary resuscitation is a life saving procedure in case of sudden cardiac
arrest
Every individual should know how to give effective CPR.
The basic principles of resuscitation are an integral part of training for many health
care providers (HCPs).
Timely interventions for cardiac arrest victims have the potential to be truly lifesaving.
CPR is unlikely to restart the heart, but rather its purpose is to maintain a flow of
oxygenated blood to the brain and the heart, thereby delaying tissue death and
extending the brief window of opportunity for a successful resuscitation without
permanent brain damage. Defibrillation and advanced life support are usually needed
to restart the heart.
3.
4. CARDIAC ARREST
Abrupt cessation of cardiac pump function which may be reversible by a
intervention but will lead to death in its absence.
SIGNS
Unresponsiveness
Absence of detectable pulse
Apnea
Agonal respiration
Change the skin color
5. Etiology of cardiac arrest
Ventricular fibrillation
Ventricular tachycardia
Ventricular asystole
Pulse less electrical activity
6. After cardiac arrest
Loss of consciousness -15sec
Flat ECG -30sec
Pupil dilated fully -60sec
Cerebral damage -90-300sec
according to 2010 AHA GUIDELINES
ABC CAB
7. SEQUENCE OF BLS
Check whether scene is safe
Approach victim and tap on his shoulder .
Ask him ‘’are u alright’’
Call for help
Start cpr
8. When you find a victim who is
unresponsive
1.If a rescuer is alone and finds unresponsive adult
-activate ems system,get AED
-Return to victim and provide cpr
2.If 2 or more rescuer are present
-one should begin cpr
- other should activate EMS system and get AED .
Activating EMS-Call on nos 108 and give information about location of
emergency,what has happened.
9. CIRCULATION
Check pulse
Carotid pulse for 10 sec
if no pulse felt ,begin cpr
carotid pulse is felt just in side of neck just in between trachea and scm
10.
11. Airway
Place victim in supine position.
HEAD TILT-CHIN LIFT maneuver done as tongue is most common cause of
airway obstruction by this manevur tongue is lifted and relieves obstruction.
JAW THRUST MANEUVER in case of neck injuries. the rescuer places his or her
finger behind the posterior border of ramus of the victim’s mandible and displaces
the mandible anteriorly while titling the victim’s head backward and opening the
mouth.
if there is any obstruction because of loose denture or any foreign material
remove if possible.
12.
13. In Emergency airway, two type of procedure is done :
1-Noninvasive procedure
Back blows
Abdominal thrust(hemlich manevur)
Chest thrust
Finger sweep
2-Invasive procedure
Tracheostomy
Cricothyrotomy
14. Non invasive procedure
Back Blow:-- when back blow are performed on the infant, infant is straddled over
the rescuer’s arm with the head lower than the trunk and with the head supported
by the rescuer’s firm hold on infant’s jaw. Using the heal of hand, the rescuer
delivers up to five back slaps forcefully between the infant’s shoulder blades while
resting the other hand on the thigh.
15. Heilmlich maneuver: also known as subdiaphragmatic abdominal thrust,was first described in
1975 by Dr. Henry J. Heimlich. Today this maneuver is recommended primary technique for relief
of foreign body airway obstruction in adults and children.
If the patient is conscious and either standing or sitting , the following recommended steps should
be performed after the rescuer confirms that airway is obstructed by asking “Are you choking”
1. Stand behind the victim and wrap your arms around the wrist and under the arms.
2. Grasp one fist with the other hand, placing the thumb side of fist against the victim’s
abdomen. The hand should rest in the midline, slightly above the umbilicus and well below the tip
of xiphoid process.
3. Perform repeated inward and upward thrusts until the foreign body is expelled or victim
loses consciousness.
16. Chest Thrust: The chest thrust is an alternative in special situations only to the
Heimlich maneuver as a technique for opening an obstructed airway.
Conscious Victim:
1. Stand behind the victim and place the arms directly under armpits, encircling
the chest
2. Grasp on fist with other hand, placing the thumb side of fist on middle of
sternum, not on the xiphoid process or margins of rib cage.
3. Perform backward thrusts until the foreign body is expelled or victim loses
unconscious
17. Finger Sweep: in the conscious victim it is quite difficult for rescuer to remove foreign
bodies from the airway with the fingers. With loss consciousness, muscle relax and it
is considerably easier to open the victim’s mouth to seek and remove foreign objects
with ones fingers.
The finger sweep is performed as follows:
1. The victim is placed into supine position with the head in neutral position.
2. The rescuer should open the Victim’s mouth by using the crossed-finger
technique. Open the victim’s mouth by crossing the index finger and thumb between
teeth and forcing the teeth apart.
3. To perform a finger sweep, place the index finger of the other hand along inside
of victim’s cheek and advance it deeply into pharynx at base of tongue.
18. non invasive procedure
However, situations do occur in which noninvasive techniques are ineffective. In
this situation and others, such as then airway obstruction is caused by swelling of
tissues due to allergy or illness, invasive procedure may be required if the victim
is to survive.
1.CRICOTHYROIDECTOMY
2.TRACHEOSTOMY
26. BAG VALVE MASK
Adults 12 times per minute ( once
every 5 seconds)
Child 15 times per minute (once every
4 seconds)
Infants 20 per minute ( once every 3
seconds)
32. Breathing
Look, listen and feel for breathing
No longer than 10 seconds
If the victim is not breathing, give two breaths (1 second or longer)
Pinch the nose
Seal the mouth with yours
If the first two don’t go in, re-tilt and give two more breaths
(if breaths still do not go in, suspect choking)
Prevent stomach distention
33. The operator must control or assist ventilation to ensure adequate oxygenation of
the patient
The Ambu bag is convenient, since it may be used with or without oxygen. Care
must be taken to make certain that there are no leaks around the mask, which
would prevent sufficient air form being forced into the lungs.
The operator the opens his mouth wide enough to cover the patient’s mouth. He
should take a deep inspiration before each expiration into the patient’s mouth. On
can readily determine if the air is reaching the patient’s lungs by observing the
rise and fall of the chest wall.
34. Prevention of Stomach Distension
Don’t blow too hard
Slow rescue breathing
Re-tilt the head to make sure the airway is open
Use mouth to nose method
35. Automated external defibrillator
AED can be easily used by untrained rescuers.
Automated detection of defibrillatable rythms
Portable.
36. PLACEMENT OF AED
Anterolateral
Anteroposterior
Antero left infrascapular
Antero right infrascapular
Size-8-12 cm
It uses conductive material like gel pads or electrode paste or self adhesive pads
37. Technique
1. power on the AED
2.Attach electrode pads to patients bare chest
3.analyse rhythm
4.deliver shock if advisable.
after shock delivered resume CPR
30:2 cycle
after 2 min of cpr,AED will prompt you to analyze rhythm and deliver shock again.
38. ADVANCED CARDIAC LIFE
SUPPORT
It helps to restore spontaneous circulatory function.
It includes new adjunctive equipment and techniques available in hospital set up
assisting ventilation and circulation(ecg monitoring,defibrillation,iv drugs)
DRUGS GIVEN
1.Adrenaline-1mg iv every 3-5 min
2.vasopressin-40unit iv
3.lidocaine-1-1.5 mg/kg every3-5 min
4.Sodium bicarbonate-1gm/kg every 10 min
39. CPR in childrens
The lower margin of the victim’s rib cage is located with the rescuer’s middle and
index fingers.
The margin of the rib cage is followed with the middle finger to the notch in the
midline where the right and left side ribs meet.
With the middle finger in this notch, the index finger is placed next to the middle
finger.
The heal of the hand is placed next to the index finger with the long axis of the
heal parallel to the sternum.
The chest is compressed with one hand to a depth of 2.5 to 3.8 cm at a ratio of 5
compressions and 1 ventilation at a rate of 100 compressions per minute.
40. CPR in infants
In the infant the site of compression is somewhat different. Evidence has shown that
the heart of the infant is lower in relation to external chest landmarks.
An imaginary line is drawn between the nipples located over the sternum intermamary
line.
The index finger of the hand farthest from the infant’s head is placed just under the
intermamary line where it intersects the sternum. The area of compression is one
finger’s width below this intersection, at the location of the middle and ring fingers.
While using two or three fingers, the sternum is compressed to a depth of 1.3 to 2.5
cm at a ratio of 5 compressions and 1 ventilation at a rate of 100 compressions per
minute.
41.
42. How CPR Works ?
Effective CPR provides 1/4 to 1/3 normal blood flow
Rescue breaths contain 16% oxygen
Peak SP 60-80mmg
During Chest compression:
1.Compression phase
Increased intrathoresic pressure
Mechanically compress the heart
2.Decompression phase
Chest wall recoil cause a small, transient decreased intrathoresic pressure that return venous blood to the
right heart, incomplete recoil reduce the vacuum created during chest compression
43. Complication of CPR:
Fracture of the ribs and sternum.
Separation and fracture of the costochondral junction
Fat and bone marrow emboli
Hemothorax
Penumothorax
Hemopericardiaum
Lacerations of the liver, spleen and stomach
44. Four indicators may be observed
colour of the skin and mucous membrane: return to normal skin and mucous
membrane colour
carotid pulse: carotid pulse should be feel with each compression
Respiratory movement: observe for the spontaneous respiratory movement. The
rescuer should never pause for more than 5 seconds at a time, because during this
time blood flow drops to zero.
Pupils of the eye: in normal patient pupils normally respond to light by constriction or
narrowing. While in unconscious individual, pupil dilates, indicating that the brain is
receiving less than adequate supply of oxygen. If pupils constrict when exposed to
light, that is a sign that oxygenation and cerebral blood flow are adequate.
45. When Can I Stop basic life support ?
Victim revives
Trained help arrives
Too exhausted to continue
Unsafe scene
Physician directed (do not resuscitate orders)
46. 1.Delay in starting
2.Improper procedures (ex. Forget to pinch nose)
3.No ACLS follow-up and delay in defibrillation
4.Improper techniques
5.Terminal disease or unmanageable disease
(massive heart attack)
47. Atlas Of Airway Management- Steven Renbaugh
Abc Of Resuscitation-a J Handley
Rowe And Williams Vol-1
Medical Emergencies In The Dental Office:- Stanley F. Malamed
Fonseca trauma vol-1
Internet
AGONAL RESP IS ABNORMALPATTERN OF BREATHING,GASPING FOR BREATHE.
1.dysrhythmia in which individual myocardial bundles contract chaotically and independently of each other in contradistinction to the normal, regular, coordinated, and synchronized contraction of myocardial fibers, as occurs in normal sinus rhythm.2-4 hrs
2.accelerated beating of the ventricles. Each contraction represents as organized heartbeat termed a premature ventricular contraction.
: refers to the absence of contractile movement of myocardium fibers. . A severe lack of oxygen to myocardium muscle is the most common cause of this situation.
3heart continues to beat in coordinated manner, but so weakly that effective circulation of blood throughout the cardiovascular system is not accomplished. . 4.Pulse less electrical activity most commonly results from hypovolemia, hypoxia, acidosis, hypo or hyperkalemia, hypoglycemia, hypothermia, cardiac tenponade
While head extension is maintained with one hand, the other hand located the victim’s larynx. The fingers are then moved laterally into the groove between the trachea and the muscles at the side of the neck where the carotid pulse can be felt.
With the clinician positioned to the side of the victim, the lower margin of the rib cage is located with the middle and index fingers of the hand
. The fingers the run along the rib cage toward the midline to locate the inferior border of the sternum. ; the fist hand is then placed on top of the hand on the sternum. The operator’s elbows are straightened and the shoulders positioned directly over the hands. For normal sized adult, sufficient pressure must be applied to depress the sternum 4 to 5 cm. this procedure compresses the heart between the sternum and vertebral column forcing blood from it into the systemic circulation.
; the fist hand is then placed on top of the hand on the sternum. The operator’s elbows are straightened and the shoulders positioned directly over the hands. For normal sized adult, sufficient pressure must be applied to depress the sternum 4 to 5 cm. this procedure compresses the heart between the sternum and vertebral column forcing blood from it into the systemic circulation.
In order to be effective, a bag valve mask
must deliver between 500 and 800 milliliters of air to the patient's lungs, but if oxygen is provided through the tubing
and if the patient's chest rises with each inhalation (indicating that adequate amounts of air are reaching the lungs),
1] Squeezing the bag once every 5 seconds for an adult or once every 3 seconds
for an infant or child provides an adequate respiratory rate (12 respirations per minute in an adult and 20 per minute
in a child or infant).
ALSO CALLED GUEDELS PATTERN AIRWAY
USED TO MAINTAIN OR OPEN PATIENTS AIRWAY…..SIZE IS SELECTED FROM MIDPOINT OF INCISOR TO ANGLE OF MANDIBLE
After correct
Endoctracheal intubation- the passage of a tube through
the nose or mouth into the trachea for maintenance of the (23CM IN MALE,21FEMALE)
airway during anesthesia or for maintenance of an imperiled
airway. This is considered a relatively temporary
procedure. The type of intubation used depends on the
patient's condition and on the purpose for intubation
Endoctracheal intubation- the passage of a tube through
the nose or mouth into the trachea for maintenance of the
airway during anesthesia or for maintenance of an imperiled
airway. This is considered a relatively temporary
procedure. The type of intubation used depends on the
patient's condition and on the purpose for intubation
Endoctracheal intubation- the passage of a tube through
the nose or mouth into the trachea for maintenance of the
airway during anesthesia or for maintenance of an imperiled
airway. This is considered a relatively temporary
procedure. The type of intubation used depends on the
patient's condition and on the purpose for intubation
Nasotracheal intubation- (blind) the insertion of an endotracheal tube through the nose and into the trachea. The tube is passed without using a laryngoscope to view the glottic opening. This technique may be used without hyperextension, therefore it is useful when a client or has cervical spinal trauma and with patients who have
clenched teeth. Indications for this type include intraoral operative procedures, during which the the endotracheal tube could easily be displaced or obscure
the operative site. Bleeding is not unusual after
intubation. The tubes are usually smaller than those
used for orotracheal intubation. This can also be
performed with direct visualization with a laryngoscopic
examination. Blind intubation is only used if there are
indications that the larynx can not be visualized.
