CARDIOPULMONARY RESUSCITATION

1. Presented to: Mrs. Sameeksha Patial
(Assistant Professor, ACN)
Presented by: Ms. Yoshita Sood
BS22MHNS022
Presented on: May 20, 2023
CARDIOPULMONARY
RESUSCITATION
4/19/2023
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2. HISTORY
 1732- First medical BLS by William Tossach
 1780- First attempt of newborn resuscitation by blowing
 1858- method of restoring natural breathing by Dr. H.R. Silvester
 1992- First attempt of external chest compression
 1949- First report of mouth to mouth ventilation to cardiac arrest
victim by James
 1991- Chain of survival by AHA
 2000- First International CPR Guidelines by ILCOR
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3. DEFINITION
 It is an emergency life saving procedure performed when the heart
stops breathing.
 CPR can be initiated anytime an individual cannot adequately
oxygenate or perfuse vital organs- not only following cardiac or
respiratory arrest.
 CPR is an emergency procedure that combines chest compressions
with artificial ventilation in an effort to manually intact brain function
until further measures to restore spontaneous blood circulation and
breathing in a person who is in cardiac arrest.
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4. PURPOSES
 To maintain a clear and open airway.
 To maintain breathing by external ventilation.
 To maintain blood circulation by external cardiac massage.
 To save life of the patient.
 To provide basic life support till advanced and medical life
support arrives.
 To reverse the initiating patho-physiological event.
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5. WHEN TO GIVE? WHEN NOT TO GIVE?
 Unconscious
 Person not breathing
 Has an abnormal pulse
rate
 Heart abruptly stopped
beating
 Neither scene nor
victim and rescuer is
safe
 Patient has developed
rigor mortis
 Normal pulse and
breathing
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6. INDICATIONS
 Acute Myocardial Infarction
 Cardiomyopathy
 Congestive heart failure
 Cardiac temponade
 Acute coronary syndrome
 Hypoxia
 Tension pneumothorax
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7. GOLDEN RULES TO BE KEPT IN
MIND
 Optimise chest compressions rate : 100-125 compression per
minute.
 Optimise compression depth : 50mm
 Minimise interruptions
 Promote full chest recoil
 Control breathing and ventilation
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8. TYPES
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9. BLS ( BASIC LIFE SUPPORT)
 BLS is the foundation of saving lives after cardiac arrest.
 A level of medical care which is used for victims of life
threatening illnesses or injuries until they can be given full
medical care at the hospital.
 Provided by a trained health professional.
 Includes psychomotor skills to perform high quality CPR , using
an AED and relieve an obstructed airway.
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10. OBJECTIVES OF BLS
 It is primary medical aid provided in an emergency medical
situation.
 Objective here is not to “treat” the person but to buy some
valuable time until the emergency team arrives.
 BLS is performed by anyone who knows how to do it, anywhere,
immediately without any other equipment.
 To reverse the initiating patho-physiological condition.
 To “save hearts too good to die” while preventing irreversible
cerebral damage from anoxia.
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11. SEQUENCE
 C- compression
 A- airway
 B- breathing
 A- airway
 B- breathing
 C- compression
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12. WHY C-A-B??
 To emphasize the simplest but the most important step.
 To increase survival rate in sudden cardiac arrest.
 Patient’s blood stays oxygenated for 4-6 minutes after last breath
but circulation should be restarted at the earliest.
 Rescue breathing almost always delays chest compressions.
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14. COMPONENTS
Ensure scene safety
Check for response and
assessment
Call for help
Activate EMS
Chest compressions
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15. INITIAL STEPS
Level of consciousness:
 Tap person gently on the shoulder
 Shout “ Are you okay?”
Circulation and breathing:
 Check for carotid pulsation for not more than 10 seconds but 5 seconds
 Check for respiration, if there is at all any sign of it
 Agonal breaths
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16. CONTD.
Call for help:
 Seek help from bystanders, other providers or from any trained individual.
Activate EMS:
 Dial up 102/108 for EMS.
 Activate CODE BLUE for in-patients.
 Kolkata Accident Response and Medical Assistance(KARMA)
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17. CONTD.
Outcome
assessment
Normal
breathing,
pulse felt
monitor
No normal
breathing,
pulse felt
No normal
breathing,
pulse absent
Start CPR
immediately
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18. CHEST COMPRESSIONS
 It is foundation of CPR.
 Continued emphasis on providing high quality CPR.
 Push hard, push fast.
 Hands-only CPR.
 Rescuer should be at victim’s side.
 Patient should be supine on flat, firm surface.
 Chest is exposed adequately.
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19. CONTD.
 Heel of the hand is placed in the centre of the chest on the lower
half of sternum.
 Other hand is placed on top.
 Fingers are interlaced.
 Arms are kept as straight as possible. Shoulder directly over the
hands. Elbows are locked.
 Movement of the rescuer should be from the hip joint.
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21. HIGH QUALITY CPR(ADULT)
 Push hard (at least 2 inches) and fast (100-120/min)
 Allow complete chest recoil.
 Minimize interruptions in compressions.
 Avoid excessive ventilation.
 Change compressor every 2 minutes, or sooner if fatigued.
 If no advanced airway, 30:2 compression-ventilation ratio.
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22. AIRWAY ASSESSMENT AND BREATHING
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24. RESCUE BREATH
Mouth to mouth:
 Open airway- Pinch the nose seal mouth to mouth contact- Blow
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25. CONTD.
Mouth to barrier device breathing:
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26. THE KISS
OF LIFE
Award winning 1967
photo was taken by Rocco
Morabito . Champion
Randall (hanging down
after a cardiac arrest
following electrocuted)
and JD Thompson (giving
mouth to mouth
ventilation). CPR was
given when Champion
was brought down and
survived and died of heart
failure in 2002 at the age
of 64.
This photograph won
Pulitzer Prize in 1968.
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28. AUTOMATED EXTERNAL DEFIBRILLATOR
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 AED is a portable electronic device that automatically analyses the
patient’s rhythm and can provide defibrillation, an electric shock that
may help the heart re-establish a perfusing rhythm.
 AED is an integral part of BLS protocol.
 Early defibrillation has been re-emphasized in all updates.
 AED’s deliver defibrillations to specific two shockable dysrhythmias:
1. Ventricular fibrillation
2. Ventricular tachycardia

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33. RECOVERY POSITION
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 MODIFIED H.A.I.N.E.S. POSITION
“ High Arm In Endangered Spine” position ( for patients with
suspected spine injury)

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35. ACLS
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 Advanced cardiac life support, advanced cardiovascular life support
refers to a set of clinical guidelines for the urgent and emergent
treatment of life-threatening cardiovascular conditions that will cause
or have caused cardiac arrest, using advanced medical procedures,
medications, and techniques.

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37. ADENOSINE
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 Uses: Supra ventricular Tachycardia (SVT)
 Dosage : 1st dose- 6mg rapid IV push followed by saline bolus,
2nd dose- 12mg rapid IV push in 1-2 minutes
 Side effects: Headache, dizziness, metallic taste, dyspnea,
hypotension , bradycardia, nausea, flushing, sweating

38. EPINEPHRINE
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 Uses: cardiac arrest, anaphylaxis, symptomatic bradycardia after
atropine
 Dosage: Cardiac arrest- 1mg IV
 Side effects: tremors, dizziness, SVT, VT, Palpitations, chest pain
, nausea, vomiting, hyperglycemia, vasoconstriction

39. AMIODARONE
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 Class III antiarrhythmic agent
 Dosage : 300mg rapid bolus with 2nd dose of 150mg if necessary
to a maximum of 2.2 grams over 24 hrs.
 Side effects: significant hypotension, dizziness, bradycardia,
torsades de pointes, tremors

40. LIDOCAINE HCL 2%
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 Uses: cardiac arrest from VF , wide complex tachycardia
 Dosage : cardiac arrest: 1-1.5mg/kg IV bolus; may repeat twice at
half dose in 5-10 minutes to total of 3mg/kg
 Side effects : seizures, bradycardia, dyspnea, tachycardia, vomiting
, headache, dizziness, tremor, drowsiness, tinnitus

41. MAGNESIUM SULFATE
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 Uses: Torsades de pointes; hypo-magnesemia; digitalis toxicity
 Dosage: cardiac arrest due to hypomagnesemia: 1-2 gm IV bolus
 Torsades with pulse: 1-2 gm IV over 5-60 minutes followed by
infusion at 0.5-1 gm per hr IV
 Side effects: confusion, sedation, weakness, respiratory
depression, hypotension

42. RESEARCH ARTICLE
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 The impact of cardiopulmonary resuscitation (CPR) training on
schoolchildren and their CPR knowledge, attitudes toward CPR, and
willingness to help others and to perform CPR: mixed methods
research design.
 RESULT: Significant progress in cardiopulmonary resuscitation
knowledge was noted after training implementation, with the greatest
progress seen in the youngest age group (mean age 12.5). The greatest
increase after training was seen for the variables Attitude toward
helping others (p = 0.001) and Self-confidence (p = 0.001).

43. CONTD.
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 The efficacy of an ACLS training program for resuscitation from cardiac
arrest in a rural community.
 Study objective: To determine whether an advanced cardiac life support
(ACLS) course in a rural hospital will improve resuscitation success from
cardiac arrest.
 Result: Overall, seven of 35 patients (20%) were resuscitated successfully in
the post-ACLS period, with two patients surviving to hospital discharge. This
was not significantly different than the two of 29 patients (7%) resuscitated in
the pre-ACLS period, with one patient surviving to discharge.

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45. ANY QUERIES?
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