The document discusses Cardiopulmonary Resuscitation (CPR), including Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). It defines CPR as a technique used to provide oxygen to the heart, lungs and brain until normal function can be restored. BLS involves opening the airway, checking breathing, performing chest compressions, and using an AED. ACLS uses medications like epinephrine, amiodarone, lidocaine and atropine in addition to BLS measures. The document outlines the procedures for performing CPR and using an AED, and lists indications, contraindications and complications of CPR. It also describes some newer manual and electric CPR assistance devices

1. CPR
(Basic Life Support /
Advanced Cardiac Life Support)
By,
Krishna V Gandhi
Rollno.10
Final Year MSC (N) - MSN
SVBCON

2. OBJECTIVES
1. To define CPR(ACLS/BLS).
2. To understand Indication and Contraindication.
3. To brief purpose of CPR.
4. To explain Pathophysiology.
5. To recognize the arrest.
6. To demonstrate the procedure of CPR.
7. To enlist the criteria's to stop CPR.
8. To explain AED.
9. To learn use of medicine in ACLS.
10. To understand Simplified BLS and ACLS.
11. To describe the New CPR devices used.

3. What does CPR stands for?
C = Cardio (heart)
P = Pulmonary (lungs)
R = Resuscitation (recover)
• Cardio pulmonary resuscitation is a series of steps used to
establish artificial ventilation and circulation in the patient who is
not breathing and has no pulse.

4. Basic life support
• Basic life support consist of a series of action and skills performed by
the rescuer based on assessment findings.
• Take rapid decision because irreversible brain damage may occur
within 4mins of cardiac arrest.

5. DEFINITION
• Cardio pulmonary resuscitation (CPR) is a technique of basic life
support for the purpose of oxygenation to the heart, lungs and brain
until and unless the appropriate medical treatment can come and
restore the normal cardiopulmonary function.

6. DEFINITION
• Basic life support is a specific level of pre hospital medical care
provided by trained responders, including emergency medical
technicians in the absence of advanced medical care
• BLS generally does not include the use of drug/ invasive procedures /
skills and can be contrasted with the provision of ACLS.
• CPR provided in the field by the time for higher medical responders to
arrive and provide ACLS.

7. PURPOSE
• Restore cardiopulmonary functioning.
• Prevent irreversible brain damage from anoxia.
INDICATION
• Cardiac arrest
• Respiratory arrest
• Combination of both

8. CONTRAINDICATION
• The only absolute contraindication to CPR is a do-not-resuscitate
(DNR) order or other advanced directive indicating a person's desire to
not be resuscitated in the event of cardiac arrest.
• A relative contraindication to performing CPR is if a clinician
justifiably feels that the intervention would be medically futile.

9. COMPLICATION
1. RIB FRACTURES
2. FRACTURE STERNUM
3. RIB SEPARATION
4. PNEUMOTHORAX
5. HEMOTHORAX
6. LUNG CONTUSIONS
7. LIVER LACERATIONS

10. BLS CONSISTS OF THE FOLLOWING
SEQUENCE OF ACTIONS:
• Make sure the victim, any by standers and you are safe;
• Check the victim for a response.
• Gentle shake his shoulder and ask loudly
“ARE YOU ALL RIGHT???”
No breathing
No pulse felt within 10seconds.

11. If he responds;
• Leave him in the position in which you find him provided there is no
further danger
• Try to find out what is wrong with him/her and get help if needed.
• Reassess him regularly.
If he doesn't responds;
• Shout for help
• Turn the victim supine aligned position/stable side position.

12. CARDIAC ARREST
No blood or tissue
oxygenation
Brain sustain damage for 4 min and after 7 min
irreversible damage occurs
After 1-2 hrs, cells of body die
CPR
Causes blood to circulate to
brain and heart
• Enough blood to
brain delaying
brain death
• allows heart to
remain
responsive till
defibrillation

13. RECOGNITION OF ARREST
• First step is to Ensure scene safety
• Check for response
• Shout for help/activate resuscitation team at the time or after checking
pulse and breathing
• Activation of AED/emergency equipment's either by one rescuer or
person sent by rescuer must occur as soon as possible after
checking pulse and breathing (ideally should be done
simultaneously)
• Immediately begin CPR and use AED/defib when available

14. AVPU ASSESSMENT

15. Check breathing?
Inspecting the chest rise of patient while palpating carotid pulse (saves
time) 5 SECOND AND NOT MORE THAN 10 SEC

16. LOOK, LISTEN AND FEEL
Lay rescuer can check by keeping our fingers in front of nostrils/keeping ears
close to nose to check if any blow of expired air is present or not.
If a pulse is felt give one more rescue breath, every 5 to 6 sec and recheck the
pulse every 2min. If no pulse are felt initiates CAB

17. POSITION ON BACK
• All body rolled over at the same time.
• Always be aware of head and spinal cord injuries.
• Support neck and spinal column laying patient in supine on hard
surface.
• Hard surface allow effective compression of the sternum

18. CHEST COMPRESSION
• Interlock finger and arms straight, elbow locking helps maintain
straight arms. Use your upper body weight to compress.
• Position of hand is midline of the nipple OR two finger above the
xiphoid process of sternum

19. • 100 compression / minute to max. 120/min
• Depth = 2inches / 5cm for adult
• 30 CHEST COMPRESSION FOLLOWED WITH 2 VENTILATION
• In the presence of 2 rescuers chest compressions must not be
interrupted for ventilation

20. CHILD CONSIDERATION
DEPTH=1.5INCHES
ONE RESCUER = 30:2
TWO RESCUER = 15:2

21. Chest compressions must be continued for 2 minutes before
reassessment of cardiac rhythm.
► Golden rules:
• Ensure high quality chest compressions: rate, depth, recoil.
• Plan actions before interrupting CPR.
• MINIMIZE interruption of chest compressions.
• Early defibrillation of shockable rhythm.

22. AIRWAY
• A patent airway is essential to facilitate proper ventilation and
oxygenation.
• Loss of consciousness often results in airway obstruction due to loss of
tone in the muscle of the airway and falling back of the tongue

23. Head tilt chin lift
one hand is placed on the forehead and the other on the chin the head is
tilted upwards to cause anterior displacement of the tongue.

24. Jaw thrust maneuver

25. Sweep out
sweep out foreign body in the mouth by index finger in
unconscious pt only. This is NOT advised in a conscious or
convulsing patient

26. Heimlich maneuver
If the patient is conscious or the
foreign body cannot be removed by
a finger sweep. It is done while the
patient is standing up or lying
down. This is a subdiaphragmatic
abdominal thrust that elevates the
diaphragm expelling a blast of air
from the lungs that displaces the
foreign body. In infants his can be
done by a series of blows on he
back and chest thrusts.

27. BREATHING
Breathe for the person Rescue breathing can be mouth-to-mouth
breathing or mouth-to-nose breathing if the mouth is seriously injured or
can't be opened.
With the airway open (using the head-tilt, chin-lift maneuver), pinch the
nostrils shut for mouth-to- mouth breathing and cover the person's
mouth with yours, making a seal.

28. Mouth To Mouth Breathing
With the airway held open, pinch the nostrils closed, take a deep breath
and seal your lips over he patients mouth. Blow steadily into the patients
mouth watching the chest rise as if the patient was taking a deep breath.

29. Mouth To Nose Breathing
Seal the mouth shut and breathe steadily though the nose. used in
infants and small children.

30. Pocket mask ventilation

31. • Bag – Valve Mask ventilation
• Position yourself directly above patient’s head
• Use the E- C hand position (first rescuer)
• Make “C” with thumb and index finger of one hand.
• When we use 3 fingers, it forms “E”
• Chest rise is checked while squeezing the bag to give breaths to
the patient.
• Depress the bag about half way to deliver the between 400-700ml of volume to
make the chest rise.
• Give a smooth & effortless ventilation that last
for 1 second.

32. • This barrier helps to protect from patient blood, vomitus, saliva and
the breath the air that the patient exhale.
• When using the pocket mask, make sure the use one of the patient
size.

33. WHEN TO STOP CPR?
• Once started continue CPR for 30 compression followed with 2
ventilation
• You see the sign of return of spontaneous circulation (ROCS) such as
patient movement or breathing
• An AED is ready to analyze the patient heart rhythm
• Other trained rescuer takes over and relieve you from
compression/ventilation responsibilities
• Presented with DNR order
• Alone and exhausted
• The scene becomes unsafe

34. RECOVERY POSITION
• The modified HAINES (High Arm In Endangered Spine) position
used for situations in which the patient is suspected to spinal injury
Do the following:
1. Kneel at the side of the patient and roll the patient towards the
rescuer.
2. Place the top leg on the other with both knee in a bent position.
3. Align the arm of top with the upper body.

35. IF THE PATIENT IS INFANT:
• Carefully position the infant face down along the forearm
• Support the infant head and neck with your other hand while keeping
the infant mouth and nose clear
• Keep the head and neck slightly lower than the chest

37. Automated External Defibrillator
• AED are a portable type of external defibrillator that automatically
diagnose the ventricular fibrillation in a patient.
• Automatic refers to the ability to autonomously analyze the patients
condition.
• AED is provided with self-adhesive electrodes instead of hand held
paddles.

38. Using a AED
• Turn it on
• Patient chest is clearly exposed and dry
• Remove any medicine patch if found with a
gloved hand
• Remove undergarment that may be in the way the
pads needed to be adhered to the skin
• Apply the appropriate size pad
• Position of pad : 1 - Right clavicle
2 – Left mid axillary line
few inches below the left
armpit

39. • Plug in the connector and push the analyze button if necessary.
• Tell everyone to “CLEAR”, ensure no one is touching the patient
during the analysis / shock.
• Deliver shock by pressing shock button.
• Observe AED analysis and prepare for a shock to be delivered if
advised.
• After shock delivery immediately start compression and perform about
2minutes of CPR.

40. TYPES OF AED

41. PRINCIPLES OF AED
1. The discharge resistance which the patient represents as purely
ohmic resistance of 50 to 100Ω approximately for a typical electrode
size of 80cm
2. This particular waveform Fig is called „ Lown‟ waveform.
3. The pulse width of this waveform is generally 10 ms.
4. Energy storage capacitor is charged at relatively slow rate from AC
line.
5. Energy stored in capacitor is then delivered at a relatively rapid rate
to chest of the patient.
6. Simple arrangement involve the discharge of capacitor energy
through the patient's own resistance.

42. MEDICINE
ADRENALINE
• Sympathomimetic drug
• Action – alpha and beta adrenergic action having approximately equal
activity on both receptors.
• Dose – IV bolus of 1mg followed by 10-20 cc NS , 3 dose in 15mins
• Positive Inotrope and Positive Chronotropic
• Precaution – should not be infused with alkaline solution.
- can exacerbate ischemia and induce ventricular ectopy.

43. AMIODARONE
• ANTI ARRYTHMETIC drug
• MAIN USE IN ACLS
• VF/pulseless VT
• VT with pulse
• Tachycardia rate control
• Action – Effect on Na+ , K+, Ca++ channels, alpha & beta adrenergic blocking property, Class 3
antiarrhythmic agent.
• Has direct action in isolated myocardial preparation to decrease delayed slow outward k+ current and in
higher doses additionally decrease fast & slow inward current due to Na++ & ca++ respectively.
• Dosage: In VF/VT : 300 mg bolus followed by 1MG/MIN for first 6 hours then 0.5mg / hr for next
18hrs
• Additional 150 mg bolus can be given for break through arrhythmic upto a load of approx 2g/24hr
• Can be loaded orally (800 - 1600 mg daily)

44. FOR CARDIAC ARREST
• Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000)
• Maintain: 0.1 to 0.5 mcg/kg/min Titrate to desire blood pressure
• 0.3-0.5 mg IM
• Repeat every 5 mins as needed
FOR ANAPHLAXIS

45. Adverse effect:
• Hypotension
• Bradycardia
• causes QT prolongation
• Exacerbation of CHF
• Phlebitis
• Hepatitis / Neuropathy

46. LIDOCAINE
It can be used in ACLS when aminodarone is not available.
Mechanism : It suppresses autonomaticity of conduction tissue in heart
by increasing the electrical stimulation threshold of the ventricles,
Purkinjin fibre & cause spontaneous depolarization of ventricles during
diastole by direct action on the tissue.
DOSAGE:
1 to 1.5 mg/kg : Dose I
0.5 to 0.75 Mg/kg : Dose II at 5-10min interval
max upto 3mg/kg.

47. ATROPINE
Anticholinergic, Antispasmodic Agents.
• 0.5 mg IV/IO every 3 to 5 minutes
• Max Dose: 3 mg
• Minimum dose 0.5 mg
• MAIN USE IN ACLS: Symptomatic Bradycardia, Specific Toxins/overdose (e.g.
organophosphates)
• Cardiac and BP monitoring
• Do not use in glaucoma or tachyarrhythmias

48. DOPAMINE
Inotropic Agents.
• MAIN USE IN ACLS : SHOCK/CHF
• 2 to 20 mcg/kg/min
• Titrate to desired blood pressure
• Fluid resuscitation first
• Cardiac and BP monitoring

49. MAGNESIUM SULFATE
• Antidysrhythmics
• Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP
• If not Cardiac Arrest: 1 to 2 gm IV over 5 to 60 min
• Maintain: 0.5 to 1 gm/hr IV
• Cardiac and BP monitoring
• Rapid bolus can cause hypotension and bradycardia
• Use with caution in renal failure
• Calcium chloride can reverse
hypermagnesemia

50. PROCAINAMIDE
• Used in the management and treatment of ventricular arrhythmias,
supraventricular arrhythmias, atrial flutter, atrial fibrillation.
• Class 1A antiarrhythmic agent.
• 20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS
widens by 50%
• MAX dose: 17 mg/kg
• Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min

51. NEWER INNOVATION
New CPR Devices :
• Manual
o Cardiopump
o CPR RsQ assist
o CPR PRO cradle
o Lifebelt
o Lifestick
• Electric
o Autopulse
o Lifeline ARM
o LUCAS
• Pneumatic
o Thumper
o Lifestat
o Hydraulic-pneumatic band

52. CARDIOPUMP
• Handheld device
• Piston having a suction cup that sticks to patient’s chest
• Manual form of CPR device
• Operator operates the device by hand
• Alternate compression with active decompression increases
venous return by decreasing intrathoracic pressure and
increases overall flow

53. • Light and compact
• It has a handle which provides
support for active compression
during CPR
• Manual device, operated by rescuer
CPR RsQ ASSIST

54. • Manual device
• Have to be operated by rescuer
• Can be used for compression only
because there is no decompression
CPR PRO CRADLE

55. • Manual device
• For compression only, no decompression
• A provided levarage is pushed against the chest
LIFE BELT

56. • Dual handled rigid bar with two short
pistons with adhesive pads
• This cyclic compressions doubles the flow
and allows to decrease depth of compression
and decrease injury to sternum and ribs
LIFE STICK

57. • Electrically operated
• Consists of a load distributing band and a backboard
• The band is placed around the chest and tightened and loosened by the
motor
• It has a fixed compression rate of 80/min because it has a greater effect on
hemodynamics at lower compression rates
AUTOPULSE

58. • Electrically operated
• Piston mounted on a removable
frame placed around the chest
• The frame is fixed on a rigid
backboard
• It provides alternate compression
with active decompression by a
suction cup that forces thorax back to
its uncompressed volume (recoil)
LUCAS

59. • Pneumatically operated
• It has piston mounted on a arm fixed on a supporting column
• Rigid backboard
• It gives compressions with the rate of 100 compressions per min
THUMPER

60. 1. Basvanthappa B.T”MEDICAL SURGICAL NURSING”1st edition , 2005 Jaypee Brothers Publications,
NewDelhi,Page No.1142-1144.
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ed) Elsevier. Page No.986-990 .
3. Chintamani Lewis”MEDICAL SURGICAL NURSING ”South Asia edition 2nd volume 2015,Elseiver
Publication,Page No.1541.
4. Lewis, Heitkemper&Dirksen (2000) Medical Surgical Nursing Assessment and Management of Clinical
Problem (6 thed) Mosby. Page No.862
5. Phipps W.J., Long C.B. & Wood N.F. (2001) Shaffer’s Medical Surgical Nursing B.T.Publication Pvt. Ltd.
New Delhi. Page No.1418-1421.
BIBLIOGRAPHY

61. SUMMARY :
• SIMPLIFIED BLS
• ACLS